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Airway involvement and mechanical ventilation in Steven Johnson Syndrome and Toxic Epidermal Necrolysis management



Abstract

Steven-Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are severe drug allergic reactions characterized by skin and mucosal membrane detachments. Most of the literature focuses only on the skin and ocular mucosal damage, but more severe and life-threatening mucosal damage may actually occur in the respiratory tract. This airway involvement may cause an acute complication, e.g. acute respiratory failure, and chronic complications, e.g. bronchiolitis organizing pneumonia, bronchiectasis, and restrictive bronchiolitis. The presence of airway involvement in SJS/TEN requires a more detailed examination, ranging from examination of the ear, nose, and throat (ENT), to fiberoptic bronchoscopy done by a skilled clinician to determine the presence of bronchial epithelial detachment. A higher percentage of skin and mucosal detachment is associated with a greater need for mechanical ventilation. Male sex, age, low serum bicarbonate, high serum urea, and higher amount of infiltrate on chest X-rays are also associated with a higher risk for mechanical ventilation in patients with SJS/TEN. The general indications for intubation and mechanical ventilation in patients with SJS/TEN are respiratory failures, inability to clear the airway, shock, neurologic disorder, and uncontrollable pain. More specific indications for intubation and mechanical ventilation are oral involvement with an initial total body surface area (TBSA) during hospital admission was ≥70%, or progression of TBSA ≥15% in the first 3 days of hospitalization, or neurological disorders, or documented airway involvement based on direct laryngoscopy examination.

Keywords: Intubation Mechanical Ventilation SJS TEN
Section

References

  1. Woolum J.A., Bailey A.M., Baum R.A., Metts E.L. A Review of the Management of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. Adv Emerg Nurs J. 2019;41(1):56–64.
  2. Seminario-Vidal L., Kroshinsky D., Malachowski S.J., Sun J., Markova A., Beachkofsky T.M., et al. Society of Dermatology Hospitalists supportive care guidelines for the management of Stevens-Johnson syndrome/toxic epidermal necrolysis in adults. J Am Acad Dermatol. 2020;82(6):1553–67.
  3. Papp A., Sikora S., Evans M., Song D., Kirchhof M., Miliszewski M., et al. Treatment of toxic epidermal necrolysis by a multidisciplinary team. A review of literature and treatment results. Burns. 2018;44(4):807–15.
  4. Prost N. de, Mekontso-Dessap A., Valeyrie-Allanore L., Nhieu J.T. Van, Duong T.-A., Chosidow O., et al. Acute Respiratory Failure in Patients With Toxic Epidermal Necrolysis: Clinical Features and Factors Associated With Mechanical Ventilation*. Clin Investig. 2014;42(1):118–28.
  5. Bhullar H.K., Aung A.K., Graudins L., Ihle J., Gin D., Cleland H., et al. Upper airway involvement in Stevens–Johnson syndrome and toxic epidermal necrolysis. Burns. 2020;46(3):682–6.
  6. Williams R., Hodge J., Ingram W. Indications for intubation and early tracheostomy in patients with Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. Am J Surg. 2016;211(4):684-688.e1.
  7. Neill B.C., Seger E.W., Ferguson J.E., Hooton T., Rickstrew J.J., Rajpara A. SJS / TENN : A Mnemonic for Early Clinical Diagnosis of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis Department of Internal Medicine , Division of Dermatology. 2021;114–5.
  8. Xu N., Chen X., Wu S., Ye M., Zhang M., Tong L.I.N., et al. Chronic pulmonary complications associated with toxic epidermal necrolysis : A case report and literature review. Exp Ther Med. 2018;16:2027–31.
  9. Pannu B.S., Egan A.M., Iyer V.N. Phenytoin induced Steven - Johnson syndrome and bronchiolitis obliterans - case report and review of literature. Respir Med Case Reports. 2016;17:54–6.
  10. Bhullar H.K., Kar A., Graudins L., Ihle J., Gin D., Cleland H., et al. Upper airway involvement in Stevens - Johnson syndrome and toxic epidermal necrolysis. Burns. 2019;1–5.
  11. Kaneko Y., Seko Y., Sotozono C., Ueta M., Sato S., Shimamoto T., et al. Respiratory complications of Stevens-Johnson syndrome (SJS): 3 cases of SJS-induced obstructive bronchiolitis. Allergol Int J. 2020;69:465–7.
  12. Shah A.P., Xu H., Sime P.J., Trawick D.R. Severe airflow obstruction and eosinophilic lung disease after Stevens–Johnson syndrome. Eur Respir J. 2006;28:1276–9.
  13. Phan K., Oh L.J., Issler-fisher A., Rao A., Eugene H., Maitz P. Ventilatory support in Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: a systematic review and meta-analysis. J Dermatolog Treat. 2020;
  14. Kamada N., Kinoshita K., Togawa Y., Kobayashi T., Matsubara H., Kohno M., et al. Chronic pulmonary complications associated with toxic epidermal necrolysis : Report of a severe case with anti-Ro / SS-A and a review of the published work. J Dermatol. 2006;33:616–22.
  15. Med J., Reports C., Khanal U.P., Roy A., Sharma A.K. Bronchiolitis obliterans following toxic epidermal necrolysis : a case report. J Med Case Rep. 2021;
  16. Lebargy F., Wolkenstein P., Gisselbrecht M., Lange F., Roupie E., Revuz J., et al. Pulmonary complications in toxic epidermal necrolysis : a prospective clinical study. Intensive Care Med. 1997;23:1237–44.
  17. Beck A., Cooney R., Gamelli R.L., Mosier M.J. Predicting Mechanical Ventilation and Mortality : Early and Late Indicators in Steven – Johnson Syndrome and Toxic Epidermal Necrolysis. J Burn Care Res. 2015;37(1):7–12.
  18. Creamer D., Walsh S.A., Dziewulski P., Exton L.S., Lee H.Y., Dart J.K.G., et al. U.K. guidelines for the management of Stevens – Johnson syndrome / toxic epidermal necrolysis in adults 2016. Br J Dermatol. 2016;174:1194–227.
  19. Williams R., Hodge J., Ingram W. Indications for intubation and early tracheostomy in patients with Stevens – Johnson Syndrome and Toxic Epidermal Necrolysis. Am J Surg. 2016;9:1–5.
  20. Seminario-vidal L., Kroshinsky D., Malachowski S.J., Ergen E.N., Mauskar M., Bridges A., et al. Society of Dermatology Hospitalists supportive care guidelines for the management of Stevens-Johnson syndrome / toxic epidermal necrolysis in adults. J Am Acad Dermatol. 2020;1553–67.

How to Cite

Supono, B., Leonardo, & Veronica, S. (2022). Airway involvement and mechanical ventilation in Steven Johnson Syndrome and Toxic Epidermal Necrolysis management. Indonesia Journal of Biomedical Science, 16(2), 78–81. https://doi.org/10.15562/ijbs.v16i2.330
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