Nanfu Deng, MD, Jessica Bernica, MD, Maya Balakrishnan, MD, MPH
Baylor College of Medicine, Houston, TX
Introduction: Inflammatory bowel disease (IBD), which includes Crohn’s disease (CD) and ulcerative colitis (UC), is a GI inflammatory condition that can also affect other organ systems. We highlight a case of IBD-associated lung disease, an established but rarely recognized extraintestinal manifestation of IBD in patients who present with IBD flare and pulmonary symptoms.
Case Description/Methods: A 44-year-old man with untreated UC complicated by pyoderma gangrenosum presented with a weeping leg wound, bloody diarrhea, persistent dry cough, and dyspnea. Prior workup of his cough included CT thorax showing cavitary saccular bronchiectasis, bronchoscopy revealing airway nodules and adhesions, and negative lavage cultures. This time, he presented with worsening pulmonary symptoms characterized by tachypnea and prominent wheezing along with leukocytosis and elevated inflammatory markers. CT thorax showed worsening central bronchiectasis. Due to concern for a lung infection, the patient was started on empiric antibiotics which were later de-escalated after negative cultures. Given suspicion that the bronchiectasis may be related to his current IBD flare, he was started on IV Solumedrol with rapid improvement of respiratory symptoms and transitioned to Infliximab with improvement in his intestinal, pulmonary, and skin manifestations.
Discussion: IBD is an inflammatory process of the GI tract with a constellation of extraintestinal manifestations. One of the overlooked extraintestinal sites is the lung, which can involve the airway, interstitium, and pulmonary vasculature, with 40-60% affecting the large airways such as in bronchiectasis. IBD-associated lung disease is more prevalent among patients with UC than those with CD. Nearly 25% of IBD patients have abnormal pulmonary function tests (PFTs) or high-resolution CTs, but most remain asymptomatic. Typically, lung disease develops months to decades after GI symptoms but can also precede the diagnosis of IBD. The common embryonic origin of the GI and respiratory tracts from primitive foregut as well as mucosal associated lymphoid tissue in both organs may explain the concurrent inflammatory response. Infection must be ruled out in IBD-associated lung disease as treatment involves immunosuppression, often initially with systemic steroids with case reports also suggesting efficacy of biologics such as Infliximab. Given potential management implications, this case illustrates the importance of recognizing bronchiectasis as an extraintestinal manifestation of IBD.
Citation: Nanfu Deng, MD, Jessica Bernica, MD, Maya Balakrishnan, MD, MPH. P0534 - DO UC A FLARE IN THE BRONCHUS. Program No. P0534. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.