The autopsy of this case revealed difiuse epithelial detachment and partial regeneration of the tongue, pharynx, and trachea, all of which were thought to be caused by Stevens-Johnson syndrome. This sequence of changes in the upper airway could also involve the lower respiratory tract. In fact, several large bronchi which exhibited fibrous (Fig 2) and membranous obliteration (Fig 3) showed loss of airway epithelium and proliferation of granulation tissue distal to the obstructions. Thus, initial epithelial detachment in the airways could have caused exudation and formation of granulation tissue in the lumen, followed by epithelial regeneration with the formation of membranous and subsequently fibrous septa. This sequence of events would explain the onset of marked airway obstruction and progressive dyspnea. The interval of 24 days might have been the time necessary for these pathologic processes to induce airway obstruction after the onset of Stevens-Johnson syndrome.
Secondary pulmonary infection may be associated with postinfectious bronchiolitis obliterans; however, it is an extremely unlikely cause in this case, because chest roentgenograms remained clear until terminal dyspnea supervened. Immune complex deposition might be a possible mediator of these events. birth control pills
More interestingly, our case revealed not only bronchiolar occlusion but also obliteration of large bronchi containing cartilage, mainly at the third to fifth branches of the lobar bronchi. To our knowledge, this is only the third case report of obstruction of cartilaginous bronchi (so-called bronchitis obliterans). This has previously been reported in children following bronchitis2 or viral pneumonitis.