Ruxolitinib and Tocilizumab for Child Bronchiolitis Obliterans After Toxic Epidermal Necrolysis

Toxic epidermal necrolysis (TEN) is a life-threatening mucocutaneous disorder with rare but potentially fatal respiratory complications. We present an exceptional documented case of TEN with severe bronchial obstruction successfully treated with tocilizumab and ruxolitinib in an 11-year-old patient. Despite early methylprednisolone pulse therapy, a repeat bronchoscopy showed progressive obstruction of proximal bronchial lumen by synechiae and mucosal membranes. Following multidisciplinary discussion, treatment was intensified with tocilizumab and ruxolitinib, resulting in marked respiratory improvement and decreased proinflammatory cytokines in bronchoalveolar lavage. No adverse effects were observed during 8 months of follow-up. Recent research supports Janus kinase inhibitors as targeted therapy in TEN.