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Toxic epidermal necrolysis complicated by bronchiolitis obliterans in a child: a case report
The Case
An 11-year-old Chinese boy presented with fever, cough, oral mucosal erosion, rapidly progressive rash, and respiratory distress. Within five days, epidermal detachment involved approximately 80% of his body surface area, accompanied by extensive ocular, oral, and genital mucosal involvement.
The clinical findings supported toxic epidermal necrolysis, possibly triggered by Mycoplasma pneumoniae infection. He required invasive mechanical ventilation and received systemic glucocorticoids, intravenous immunoglobulin, plasma exchange, etanercept, antimicrobial therapy, and intensive skin, mucosal, and ophthalmologic care.
His acute illness stabilized, and the cutaneous lesions nearly completely re-epithelialized. However, persistent cough, exertional dyspnea, reduced exercise tolerance, and hypoxemia developed after discharge.
Chest computed tomography demonstrated bronchial wall thickening, diffuse hyperlucency, and mosaic attenuation. Bronchoscopy subsequently revealed extensive scarring, stenosis, membranous atresia, and fibrous obstruction of the peripheral airways, consistent with bronchiolitis obliterans.
Bronchoscopic holmium laser ablation was used to recanalize visible obstructed airways. Oxygen saturation and exercise tolerance improved, but severe irreversible airflow obstruction persisted at 21 months, with an FEV₁ of 27% predicted and an FEV₁/FVC ratio of 35%.
The child also developed severe illness-related anxiety requiring psychological counseling. He ultimately returned to full-time school and routine outdoor activities, although mild exertional dyspnea remained.
Why This Case Matters
Toxic epidermal necrolysis is principally recognized for its dramatic cutaneous and mucosal manifestations, but respiratory epithelial injury may lead to delayed and irreversible small-airway disease. Apparent cutaneous recovery should not be mistaken for complete systemic recovery.
Persistent cough, hypoxemia, exertional dyspnea, or reduced exercise tolerance after SJS/TEN should prompt evaluation for bronchiolitis obliterans, including pulmonary-function testing and expiratory chest imaging.
Although bronchoscopic holmium laser ablation was followed by symptomatic and functional improvement in this patient, the persistent severe spirometric impairment underscores the distinction between airway recanalization and reversal of established bronchiolar fibrosis. A single case cannot establish the efficacy or safety of this intervention.
Clinical Take-Home Message
Children recovering from severe toxic epidermal necrolysis require prolonged multidisciplinary surveillance. New or persistent respiratory symptoms should trigger early assessment for bronchiolitis obliterans, even after the skin and mucosal lesions have healed. Long-term care should address both irreversible organ dysfunction and the psychological consequences of critical illness.
Article: Duan G, Chen J, Li C. Toxic epidermal necrolysis complicated by bronchiolitis obliterans in a child: a case report. Journal of Medical Case Reports. 2026.
DOI: 10.1186/s13256-026-06572-0
Richard Alan Rison is the Editor-in-Chief of Journal of Medical Case reports. He is also an associate neurology editor (editorial board) for BMC Neurology, and the former lead editor for case reports of BMC Research Notes (currently on the editorial board). His scholarly work focuses on medical case reporting, reporting standards, and editorial methodology. Dr. Rison participated in the development and dissemination of the CARE guidelines for clinical case reporting and has authored numerous publications addressing both neurological disorders and the role of case reports in advancing medical knowledge. Dr. Rison practices general neurology and served as the founding medical director of the PIH Health Hospital-Whittier Stroke Program and the PIH Health Hospital-Whittier Non-Invasive Vascular Laboratory, is a clinical assistant professor of neurology at the University of Southern California Keck School of Medicine and Los Angeles County Medical Center, and is a Fellow of the American Academy of Neurology, the American Neurological Association, and the American Association of Neuromuscular and Electrodiagnostic Medicine. Dr Rison is board-certified by the American Board of Psychiatry and Neurology in neurology and vascular neurology, and neurocritical care and neuroimaging by the United Council of Neurologic Subspecialties. He is also board-certified by the American Board of Electrodiagnostic Medicine in electrodiagnostic medicine. Dr. Rison is a former president of the Los Angeles Neurological Society.
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Journal of Medical Case Reports
This journal will consider any original case report that expands the field of general medical knowledge, and original research relating to case reports.
