Réanimation

, Volume 22, Issue 1, pp 73–79 | Cite as

Atteintes bronchopulmonaires au cours des toxidermies graves

  • N. de Prost
  • A. Mekontso-Dessap
  • L. Valeyrie-Allanore
  • B. Maître
Mise au Point / Update
  • 178 Downloads

Résumé

La peau est la cible la plus fréquente des effets indésirables médicamenteux. Certaines toxidermies graves peuvent mettre en jeu le pronostic vital. Il s’agit des syndromes de Stevens-Johnson (SJS) et de Lyell (ou nécrolyse épidermique toxique, NET) et du syndrome d’hypersensibilité ou DRESS (drug rash with eosinophilia and systemic symptoms). Le pronostic des patients atteints de SJS/NET est conditionné par la survenue d’une défaillance cutanée aiguë, exposant principalement à des infections invasives et à des atteintes spécifiques d’organes, en particulier respiratoire. Les complications respiratoires surviennent dans environ 40 %des cas et peuvent être liées à une atteinte trachéobronchique spécifique, souvent précoce, ou à la survenue de complications respiratoires non spécifiques (infection, œdème pulmonaire et atélectasies), souvent retardées de quelques jours par rapport à l’admission. Dans environ 25 % des cas, un recours à la ventilation mécanique invasive est nécessaire. L’endoscopie bronchique devra être réalisée systématiquement chez les patients intubés afin d’enlever les lambeaux de muqueuse et de prévenir la survenue d’une obstruction aiguë des voies aériennes pouvant conduire au décès. L’atteinte respiratoire du DRESS est rare et réalise un tableau de pneumopathie infiltrante diffuse à éosinophile. Quelques cas de syndrome de détresse respiratoire aiguë ont été rapportés. Les formes graves sont la plupart du temps associées à d’autres atteintes viscérales, en particulier hépatiques, et sont le plus souvent corticosensibles. Dans tous les cas, l’arrêt précoce du ou des médicament(s) imputable(s) est indispensable.

Mots clés

Syndrome de Stevens-Johnson Syndrome de Lyell Nécrolyse épidermique toxique DRESS Toxidermie Syndrome de détresse respiratoire aigu 

Bronchopulmonary involvement in severe cutaneous adverse reactions

Abstract

Skin is one of the most common targets of adverse drug reactions. Life-threatening skin adverse reactions include Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and drug rash with eosinophilia and systemic symptoms (DRESS). SJS and TEN are characterized by skin and mucous membrane detachments. Respiratory complications occur in about 40% of the cases, and can be related to specific bronchial epithelial injuries as well as to nonspecific manifestations like infection, pulmonary edema, and atelectasis. Mechanical ventilation is required in about 25% of cases. Bronchoscopy is warranted in mechanically ventilated patients to remove detached mucous membranes and prevent airway obstruction. Pulmonary involvement in DRESS is rare and related to lung infiltration by eosinophils, which rarely leads to the acute respiratory distress syndrome. The most severe cases of DRESS usually present other organ involvement like cytolytic hepatitis and are usually reversible after steroid treatment. Removal of the involved drug is warranted.

Keywords

Stevens-Johnson syndrome Toxic epidermal necrolysis Severe cutaneous adverse reaction DRESS Acute respiratory distress syndrome 

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Copyright information

© Société de réanimation de langue française (SRLF) and Springer-Verlag France 2012

Authors and Affiliations

  • N. de Prost
    • 1
  • A. Mekontso-Dessap
    • 1
  • L. Valeyrie-Allanore
    • 2
  • B. Maître
    • 3
  1. 1.Service de réanimation médicalehôpital Henri-Mondor, Assistance publique-Hôpitaux de ParisCréteil cedexFrance
  2. 2.Service de dermatologie et centre de référence des maladies bulleuses immunologiques et toxiqueshôpital Henri-Mondor, Assistance publique-Hôpitaux de ParisCréteilFrance
  3. 3.Antenne de pneumologie, service de réanimation médicalehôpital Henri-Mondor Assistance publique-Hôpitaux de ParisCréteilFrance

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