198.'5; 9:27.5-6 2 Katz N, Rocha RS. Chaws A. Bull WHO 1979; .57:7Sl-S.5 3 Nash TE . Schistosonw inft·ctions in humans. Ann Intern 1\lt·d 19S2; 97:7-t0-.'5-t 4 Davidson BL. EI-Kassimi FA, Uz-Z.unan A. Pill .. i Dl,. Clll'st 19R6; 89:4.5.5-.'57 .'5 Farid JD. Fnll'iham. llahaylwh A. Ahdullah A. 1\lcmsa All . Saif 1\1 , d al. Am Rev Rt·spir Dis 1969; 100:6.51-61 6 Coutinho A, Domingut•s L. NI'\"I'S J, da Sih-a LC. Praziquantl'l in tlw tr .. atnwut of tlw hepatosplenic fimu of schistosomiasis. Summar\· of Proct·t~dings, Biltril'idt• S\·mposium on African Schistosomiasis. Nairohi. Hayt•r Phannaceuticals. HJS0:23 7 Higashi Cl, Farid Z. Oxamniquint· fen•r drug-induced or immunt'-complex reaction. Br !\It'd J 1979; 2:S.'30
Rapidly Progressive Bronchiolitis Obliterans Associated with Stevens-Johnson Syndrome* .\'aohisa Tsunoda, ,\1./J.;t 1imwaki lrmrwga, .\1./J.;t Tatsuya Saito, .\1./J.;t Satoshi Kitmrwra . .\I.D .. FC.C.P.::j: and Ken Saito , .\1./J.§
A middle-aged woman developed fulminant respiratory failure during recovery from Stevens-Johnson syndrome. Mechanical ventilation was difficult because of unusually high airway pressures, and she died one month later. Autopsy revealed not only the usual features of bronchiolitis obliterans, but also obstruction of cartilaginous bronchi. The histopathologic features suggested a relationship between bronchial obstruction and Stevens-Johnson (Chest 1990; 98:243-45) syndrome. BOOP =bronchiolitis obliterans with organizing pneumonia
On admission. tilt' patient's hlcw>d pressurt• was 110/6() n11n llg, ht'r temperaltrn• was 3H.0°C, and ht>r respiratory rate avt>raged 30/ min. Erythematous dermallt•sions associated with hlistt'rs in sen•ral places wert' ohst•rvt'd on tilt' fat·t•. thorax, hack, arms, and lt'gs. The conjuncti\ at•, lips, and huct·al mut"sa wen· also im·olv..d, showing edema and erosions. Examination of the du·st n·n•aled no ahnormal sounds. The hematocrit rt'ading was 43.2 pert·t·nt. tlw whitt- hlcH>d cdlt1lllllt was .'5.200/t·u mm. and the platt-let t1>unt was 92,()(KI/cn mm. Tht' activated partial thromboplastin tinw was prolongt•d to 101.7 s. Tilt' St'nllll lt•wl of fibrinogen degradation pnKiuct was ll011-w'ml to !6011-w'ml. suggesting the prt'St'nct• of disSt•minated intravascular coagulation. Arterial hlocKI gas analYsis rt'Vt'aled a PaCo, of 26.3 nun llg and a PaO, of .5.'3.S n11n llg (rcHnn air). Tlw chest roentgt'r10gram showt'd rdatively dt·ar lung fields. The patient was tn·att'd on an air cushion hed usually ust•d fr nursing patit•nts with hurns and received heparin, gaiK•xalt• mesilate. antibiotics. and stt'roids intravenous)~, Artt'rial hlcHKI gas values impron·d to a PaO, of 73.9 mm IIJ! and a PaCo, of 3.5. 7 mm llg em room air hy the tt•nth day in the hospital. togt'tllt'r with normali~~rtion of the platelet t1>unt and the at'linrtt•d partial thromboplastin test. The cutant'ous lesions also improved, dt•aring from tlw conjmwth·al and oral an•as hy the 12th day in tlw hospital. so tht' patient was transferred to tht> dt•rmatoloJ.,~· ward. TweiVt' days latt'r, the patient developt'd wheezing aud gradually progressiw dyspnea. A chest roentgt'nogram rt•ve:tlt•d slightly hyperinHatt'd lungs without any e\·idt'nt't' of infiltratiw lt•sions (Fig l). The PaCO, rose to 70 mm llg despitt- tlw administration of theophylline and methylprednisolont' (l,l)()() mg/day). Tilt' patient rl'tunlt'd to the ICL' on the 34th day aftt'r admission for intubation and mechanical ,·entilation . ller condition dt'lt•rioratt'd. with marked airway resistant·e and poor rt'sponsin•nt•ss to oxygen administration. and sht• dit'd on the 60th da,· aftt.•r admission. At autopsy tht• right lung Wt'ighed 370 g, and tlw left lung weighed 290 g. Both lungs were soft. light, and \uluminous. It was impossihlt• to pour frmaldehyde solution (1-cmnalin) into many segnlt'nts {lt•ft Sl + 2. 4a . .'5a. 6, ll, 9, lOa, and JOe and right Sla, 2. 3a, 4. 6, 7, 8, 9, lOa. and JOe}, ht•c:urst' of proximal ohstrudions situated in tlw third to fifth hr:mdws, numl>ehigi, Japan. tFellow, Departuwnt of Pulmonary 1\ledicirw. :j:Professor of Pulmouan· 1\ledicine. §Professor of Pathology." Reprint rt't/ut•sts: Dr. Tsunoda. Pulmorwry .\tt•dicillt', }icl!i lllt-tlical Hospital, ,\ linamikmcacl!i-machi. Kmcachi-grm. "li1chigi. japan
Frc:t •nt: I. Anteropostt•rior vit'w of dwst . showing slightly hyperinHated lungs with no significant opadtit•s. Rot•ntgt'nogram was takt•n 24 days aftt'r onst'l of Stevens-Johnson syndromt• when progrt'ssin• dyspnea dt'veloped. CHEST I 98 I 1 I JULY. 1990
243
Flrculosis or any other chronic pleuropulmonary involvenwnt. Results of physical t>xamination were unremarkahle. Hemogram was within normal limits. Chest rot>ntgenogram showed bilateral reticulonodular opacities that were (.'nse, discrett• miliary *From the Clinical Hesearch Centre (Drs. Pant, Shah, Chhahra, and Jain), V.P. Chest Institute . Univt>rsity of Delhi, and Batra Hospital and Research Institute (Dr Mathur). Tughlakahad Exh•nsimt, Delhi, India. RL•print requests: /Jr. lt111t, 2.'3-1 Kttilaslt Hills, J
Rapidly Progressive Bronchiolitis Obliterans Associated with Stevens-Johnson Syndrome* .\'aohisa Tsunoda, ,\1./J.;t 1imwaki lrmrwga, .\1./J.;t Tatsuya Saito, .\1./J.;t Satoshi Kitmrwra . .\I.D .. FC.C.P.::j: and Ken Saito , .\1./J.§
A middle-aged woman developed fulminant respiratory failure during recovery from Stevens-Johnson syndrome. Mechanical ventilation was difficult because of unusually high airway pressures, and she died one month later. Autopsy revealed not only the usual features of bronchiolitis obliterans, but also obstruction of cartilaginous bronchi. The histopathologic features suggested a relationship between bronchial obstruction and Stevens-Johnson (Chest 1990; 98:243-45) syndrome. BOOP =bronchiolitis obliterans with organizing pneumonia
On admission. tilt' patient's hlcw>d pressurt• was 110/6() n11n llg, ht'r temperaltrn• was 3H.0°C, and ht>r respiratory rate avt>raged 30/ min. Erythematous dermallt•sions associated with hlistt'rs in sen•ral places wert' ohst•rvt'd on tilt' fat·t•. thorax, hack, arms, and lt'gs. The conjuncti\ at•, lips, and huct·al mut"sa wen· also im·olv..d, showing edema and erosions. Examination of the du·st n·n•aled no ahnormal sounds. The hematocrit rt'ading was 43.2 pert·t·nt. tlw whitt- hlcH>d cdlt1lllllt was .'5.200/t·u mm. and the platt-let t1>unt was 92,()(KI/cn mm. Tht' activated partial thromboplastin tinw was prolongt•d to 101.7 s. Tilt' St'nllll lt•wl of fibrinogen degradation pnKiuct was ll011-w'ml to !6011-w'ml. suggesting the prt'St'nct• of disSt•minated intravascular coagulation. Arterial hlocKI gas analYsis rt'Vt'aled a PaCo, of 26.3 nun llg and a PaO, of .5.'3.S n11n llg (rcHnn air). Tlw chest roentgt'r10gram showt'd rdatively dt·ar lung fields. The patient was tn·att'd on an air cushion hed usually ust•d fr nursing patit•nts with hurns and received heparin, gaiK•xalt• mesilate. antibiotics. and stt'roids intravenous)~, Artt'rial hlcHKI gas values impron·d to a PaO, of 73.9 mm IIJ! and a PaCo, of 3.5. 7 mm llg em room air hy the tt•nth day in the hospital. togt'tllt'r with normali~~rtion of the platelet t1>unt and the at'linrtt•d partial thromboplastin test. The cutant'ous lesions also improved, dt•aring from tlw conjmwth·al and oral an•as hy the 12th day in tlw hospital. so tht' patient was transferred to tht> dt•rmatoloJ.,~· ward. TweiVt' days latt'r, the patient developt'd wheezing aud gradually progressiw dyspnea. A chest roentgt'nogram rt•ve:tlt•d slightly hyperinHatt'd lungs without any e\·idt'nt't' of infiltratiw lt•sions (Fig l). The PaCO, rose to 70 mm llg despitt- tlw administration of theophylline and methylprednisolont' (l,l)()() mg/day). Tilt' patient rl'tunlt'd to the ICL' on the 34th day aftt'r admission for intubation and mechanical ,·entilation . ller condition dt'lt•rioratt'd. with marked airway resistant·e and poor rt'sponsin•nt•ss to oxygen administration. and sht• dit'd on the 60th da,· aftt.•r admission. At autopsy tht• right lung Wt'ighed 370 g, and tlw left lung weighed 290 g. Both lungs were soft. light, and \uluminous. It was impossihlt• to pour frmaldehyde solution (1-cmnalin) into many segnlt'nts {lt•ft Sl + 2. 4a . .'5a. 6, ll, 9, lOa, and JOe and right Sla, 2. 3a, 4. 6, 7, 8, 9, lOa. and JOe}, ht•c:urst' of proximal ohstrudions situated in tlw third to fifth hr:mdws, numl>ehigi, Japan. tFellow, Departuwnt of Pulmonary 1\ledicirw. :j:Professor of Pulmouan· 1\ledicine. §Professor of Pathology." Reprint rt't/ut•sts: Dr. Tsunoda. Pulmorwry .\tt•dicillt', }icl!i lllt-tlical Hospital, ,\ linamikmcacl!i-machi. Kmcachi-grm. "li1chigi. japan
Frc:t •nt: I. Anteropostt•rior vit'w of dwst . showing slightly hyperinHated lungs with no significant opadtit•s. Rot•ntgt'nogram was takt•n 24 days aftt'r onst'l of Stevens-Johnson syndromt• when progrt'ssin• dyspnea dt'veloped. CHEST I 98 I 1 I JULY. 1990
243
Flrculosis or any other chronic pleuropulmonary involvenwnt. Results of physical t>xamination were unremarkahle. Hemogram was within normal limits. Chest rot>ntgenogram showed bilateral reticulonodular opacities that were (.'nse, discrett• miliary *From the Clinical Hesearch Centre (Drs. Pant, Shah, Chhahra, and Jain), V.P. Chest Institute . Univt>rsity of Delhi, and Batra Hospital and Research Institute (Dr Mathur). Tughlakahad Exh•nsimt, Delhi, India. RL•print requests: /Jr. lt111t, 2.'3-1 Kttilaslt Hills, J
