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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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