Bronchiolitis obliterans was first described by Lange in 1901. It was thought to be rapidly progressive and usually irreversible, but there have recently been reports of cases with a more favorable prognosis which respond to steroid therapy. Epler and Colby have recently classified this entity as follows: (a) a toxic-fume type; (b) a postinfectious type; (c) a type associated with connective tissue diseases; (d) localized bronchiolitis obliterans; and (e) idiopathic BOOP McLoud et al have suggested that the types associated with exposure to toxic fumes and connective tissue diseases had a relatively poor prognosis, whereas postinfectious or localized bronchiolitis obliterans and BOOP followed a better clinical course and responded to corticosteroid therapy. Buy Asthma Inhalers Online
In comparison to the previous conditions, the additional obliteration of cartilaginous bronchi, as in our case, would make the prognosis worse. Yamanaka et al have proposed “bronchobronchiolitis obliterans” as a pathologic entity. They have noted a total of eight patients with obstructive changes of both bronchi and bronchioles at autopsy, including our case. Their own five cases were of unknown etiology, but three had known underlying diseases, ie, rheumatoid arthritis, juvenile asthma, and Stevens-Johnson syndrome (our case). The condition of all of these patients deteriorated rapidly and was fatal in every case. Although it may be difficult to consider a common etiology for this unusual entity, we suggest that proximal bronchial obstruction predisposes to a more severe clinical course, compared with other types of bronchiolitis obliterans.