EC Pulmonology and Respiratory Medicine

Pulmonary involvement in inflammatory bowel disease may emerge in any location of the respiratory system from larynx to pleura. Pulmonary manifestations almost always occur following bowel inflammation. We present a case of colitis ulcerosa disease patient with severe pulmonary manifestations exhibiting simultaneous occurence with the exacerbation of the bowel disease.

A 74 year old male was admitted for fever, sputum, malaise, loss of apetite, pleural pain, dyspnea in exertion, and inflammatory discharge from a cutaneous fistula in the upper left abdomen. Physical examination displayed normal findings. Laboratory investigations were within normal limits except for mildly elevated ESR and CRP levels. Chest x-ray and thorax CT revealed peripheral pulmonary nodules in both lungs, bronchiectasis, and a left sided pleural effusion. Pulmonary function test and arterial blood gas values were normal. Pleural fluid was an exudate with a mild increase in leucocyte count.

Pulmonary complications of IBD include inflammation of small and large airways, pulmonary parenchymal disease, serositis, and pulmonary embolism. Pathogenetic mechanisms leading to pulmonary parenchymal and pleural disease consistent with inflammatory bowel disease is currently unknown. There is a great lack or gap of knowledge on the pathogenesis of inflammatory bowel diseases leading to lung dysfunction or involvement. The aim of this case report is to reveal that pulmonary involvement may emerge simultaneously with the inflammatory exacerbation of bowel disease. Our second aim was to shed light into the pathogenetic profile of the pulmonary complications of colitis ulcerosa. We suggest that inflammatory manifestations of lung involvement occur upon the same type of physiopathologic mechanisms involving the bowel in ulcerative colitis and may emerge simultaneously.

Keywords: Pulmonary Inflammation; Colitis Ulcerosa; Inflammatory Bowel Disease

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