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Case Study

Ulcerative colitis could be increasing the risk of contracting pulmonary diseases

Respiratory manifestations of ulcerative colitis can present in diverse forms and can appear before IBD is diagnosed or weeks even years afterwards.

Inflammatory bowel disease (IBD) is thought of as a multi-organ disease with frequent extra-intestinal manifestations. Pulmonary manifestations of IBD are rare, but when they occur, they pose a challenge to definitive diagnosis.

If pulmonary involvement occurs while IBD is under control, it is far more difficult to diagnose, primarily because the clinical manifestations are complicated by the effects of chemotherapy, concurrent infections and other factors. The failure to definitively diagnose pulmonary involvement then makes further treatment difficult, jeopardizing the patient’s prognosis.

A 62-year-old male with ulcerative colitis was admitted to hospital with fever. The initial diagnosis of ulcerative colitis had been made 2 years earlier.

At the time of initial diagnoses, the patient was given oral prednisolone therapy and then he was started on low-dose mesalazine, which the patient had been taking for 1 year by the time of admission. The patient reported no prior history of pulmonary symptoms or lung disease, no history of cigarette smoke, no occupational exposure, no history of extra-intestinal manifestations of IBD and no recent travel.

The analysis on admission led to a preliminary diagnosis of community-acquired pneumonia.

Two weeks later after treatment, the patient reported no discomfort, but the axial sections of chest CT showed no obvious resolution. In order to get definite diagnosis, the patient was hospitalized again for a lung biopsy.

The biopsy showed lymphocytic alveolitis, which is a side-effect of mesalazine therefore, mesalazine was discontinued. Chest CT at the end of that month showed obvious resolution of the bilateral infiltrations.

Evidence suggests that more than 50% of patients with IBD show impaired pulmonary function. Previous studies suggested that the most frequent pathological findings for pulmonary changes related to ulcerative colitis are interstitial lymphocyte infiltration, alveolar fibrinous exudates, progressive fibrosis and OP.

This case report highlights the possibility that latent pulmonary involvement in ulcerative colitis can arise not only from the colitis itself but also as an adverse effect of the drugs used to treat it.

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Posted on: December 3 2018

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Good article. I certainly appreciate this site. Continue the good work!

I was very interested in the article "Good Vs bad bacteria - the bugs responsible for Crohn's disease". I was diagnosed with IBD 6 months ago and after a very bad reaction to Pentasa (but unproven) I was told to wait and try again when the symptoms peaked again. However, I started taking Probiotics each day and (touch wood) I have been in remission for 5 months, with high hopes. I am very interested in the research in this field.

My 16 year old daughter was diagnosed with UC in July 2016 and after 4 flare ups within 12 months and trying different medications, she was prescribed infliximab. This has been the miracle medication for her and am so thankful that she has been able to return to a "relatively normal life", enjoying school and her passion for sports again (bar 8 weekly visits to PMH for inflixmab infusions, routine colonoscopies and mezzaline daily). I had very little knowledge of UC and autoimmunie disease for that matter; and was shellshocked at how debilitating it can be. We are so grateful to have a wonderful gastro and medical team supporting my daughter and of course the impact that inflixmab has had; however know it is still early days and don't want to take anything for granted.

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