Published in:
01-05-2009 | Case Report
Pulmonary Nodules as an Extra-Intestinal Manifestation of Inflammatory Bowel Disease: A Case Series and Review of the Literature
Published in: Digestive Diseases and Sciences | Issue 5/2009
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Inflammatory bowel disease (IBD) exhibits a wide spectrum of pulmonary manifestations [1]. Pulmonary nodules, however, are an uncommon extra-intestinal manifestation (EIM) of IBD with only a few cases documented in the literature (Table 1). A review of the case reports reveal that the pulmonary nodules linked to IBD exhibit a variety of histological patterns. The pulmonary nodules and respiratory symptoms relating to the lung pathology respond favorably to systemic or oral corticosteroid therapy and all patients show resolution or substantial improvement of pulmonary nodules on follow-up radiographs (Table 1). We present a case series of three patients who presented with pulmonary nodules as an EIM of IBD. The English-language literature is reviewed and we will highlight the clinical as well as histological importance of pulmonary nodules in IBD.
Table 1
Comparison of cases of pulmonary nodules as an extra-intestinal manifestation of IBD in the English-language literature
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Reference
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Age at presentation, sex
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Presenting symptoms and/or physical findings
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Thoracic radiological findings
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Histopathology of pulmonary nodules and method of tissue biopsy
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Therapy
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Outcome
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|---|---|---|---|---|---|---|
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[2]
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#1-32, F
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Patient with UC in remission presenting with constitutional symptoms and high fever
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Multiple pulmonary nodules visible on chest X-ray and CT
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Open lung biopsy-Necrobiotic lesion
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Patient #1-systemic corticosteroids
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Substantial radiographic improvement with no relapse
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#2-44, F
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Resistant to antibiotics
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Patient #2-systemic corticosteroids and cyclophosphamide
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||||
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[5]
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37, M
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Patient presented with cough, fever, and further weight loss 7 years after diagnosis of CD
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Innumerable small nodular opacities with cavitations bilaterally measuring up to 1 cm on chest CT
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Open lung biopsy-Necrobiotic lesion, BOOP and non-necrotizing granuloma
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Prednisone
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Resolution of radiographic abnormalities and improvement in respiratory symptoms
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[6]
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68, F
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Patient with CD for 14 years in remission has routine chest X-ray that showed multiple pulmonary nodules
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Subpleural nodules ranging from 1-2.5 cm on chest CT
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Transthoracic CT-guided biopsy-Heterogeneous, non-granulomatous lymphoid infiltration
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Prednisone
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Resolution of radiographic abnormalities
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[7]
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57, M
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Patient with CD in remission presented with cough, fever, dyspnea, and orthostasis
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Multiple pulmonary nodules in the peripheral lung fields up to 3 cm on chest CT
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VATS with wedge resection-Necrobiotic lesion
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Observation alone
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Resolution of respiratory symptoms and radiographic abnormalities
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[8]
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52, F
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Patient #2-Patient with UC for 5 years in remission presented with sharp right sided pleuritic chest pain for 6 months
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Bilateral pulmonary nodules with evidence of blood vessels “feeding” the lesions on chest CT
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Open lung biopsy-Necrobiotic lesion
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Prednisone
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Resolution of respiratory symptoms and radiographic abnormalities
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[4]
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38, F
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Patient with CD for 2 years in remission presented with a productive cough
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Alveolar opacities of the right middle lobe on chest CT resolved with several trials of antibiotic therapy. New alveolar opacities 1 year later with bilateral pleural involvement on chest CT.
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Transthoracic CT-guided biopsy-Initial biopsy revealed necrobiotic lesion and noncaseating epithelioid granulomas.
VATS-Second lung biopsy 1 year later showed interstitial fibrosis with lymphocytes, plasmocytes, rare eosinophils and some non-caseating epithelioid granulomas. Sparse areas of bronchiolitis obliterans
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Antibiotics and prednisolone
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Mild response clinically after several trials of antibiotic therapy. Resolution of respiratory symptoms and radiographic abnormalities after corticosteroid therapy
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