Pulmonary manifestations of Crohn’s disease

Abstract

Crohn's disease (CD) is a systemic illness with a constellation of extraintestinal manifestations affecting various organs. Of these extraintestinal manifestations of CD, those involving the lung are relatively rare. However, there is a wide array of lung manifestations, ranging from subclinical alterations, airway diseases and lung parenchymal diseases to pleural diseases and drug-related diseases. The most frequent manifestation is bronchial inflammation and suppuration with or without bronchiectasis. Bronchoalveolar lavage findings show an increased percentage of neutrophils. Drug-related pulmonary abnormalities include disorders which are directly induced by sulfasalazine, mesalamine and methotrexate, and opportunistic lung infections due to immunosuppressive treatment. In most patients, the development of pulmonary disease parallels that of intestinal disease activity. Although infrequent, clinicians dealing with CD must be aware of these, sometimes life-threatening, conditions to avoid further impairment of health status and to alleviate patient symptoms by prompt recognition and treatment. The treatment of CD-related respiratory disorders depends on the specific pattern of involvement, and in most patients, steroids are required in the initial management.

Eosinophilic Pneumonia Caused by Mesalazine: Case Report

“…Tedavide sistemik kortikosteroid kullanımı ile iyi yanıt alınmaktadır. [7][8][9][10][11][12][13] Ayrıca inflamatuar barsak hastalıklarında kullanılan ilaçlara bağlı akciğer hasarı da izlenebilmektedir. İnterstisyel akciğer hastalığına sebep olan yüzlerce ilaçtan ikisi inflamatuar barsak hastalıklarında kullanılmakta olan sülfasalazin (5-aminosalisilik asit ve sülfopiridin kombinasyonu) ve mesalazindir.…”

Extra-Intestinal Complications (EIC) and Manifestations (EIM) (Ocular and Pulmonary) among Patients with Crohn's Disease

“…Episcleritis [25] Scleritis [25] Uveitis Incidence of the pulmonary complication reported as relatively rare extra intestinal manifestation of Crohn's disease; 21% to 41% of patients with IBD patients had pulmonary complications and are more common in Crohn's disease (CD) than in ulcerative colitis (UC), 400 cases with CD has been recognized and reported in the literature with pulmonary involvement [32][33][34][35][36][37], it's occasionally possibly causing serious illness that needs pulmonary evaluation, a wide spectrum of lung manifestations , extending from subclinical changes without any symptoms, upper and lower airway diseases, parenchymal diseases of lung up to pleural involvement in addition to medication side effects. The most obvious complication is bronchial inflammation and suppuration with or without bronchiectasis.…”

“…The most obvious complication is bronchial inflammation and suppuration with or without bronchiectasis. Pulmonary complications are unusual and its pathophysiology remains unclear [34,37], but there are many mechanisms thought to be the reason of lungs involvement in CD, these include the same embryological origin of the lung and gastrointestinal tract, similar immune systems in the pulmonary and intestinal mucosa, the presence of circulating immune complexes and auto-antibodies, and the adverse effects of some drugs used to treat Crohn's disease [34,36], there is no explanation whether pulmonary involvement occurs secondary to the drugs or to the underlying disease process [37]. Intestinal disease activity is considered as the main indicator for the development of pulmonary disease, it's important to the physician possibility for the development of pulmonary disease in patients with Crohn's disease; this is to start the ideal treatment early in order to decrease other further complications [34,37], by undergoing pulmonary evaluation of physical examination, chest X-ray and pulmonary function tests are mandatory in addition to calculate diffuse lung capacity of carbon monoxide to reach a final diagnosis, bronchoscopy and thoracoscopymay be helpful [34].…”

“…Pulmonary complications are unusual and its pathophysiology remains unclear [34,37], but there are many mechanisms thought to be the reason of lungs involvement in CD, these include the same embryological origin of the lung and gastrointestinal tract, similar immune systems in the pulmonary and intestinal mucosa, the presence of circulating immune complexes and auto-antibodies, and the adverse effects of some drugs used to treat Crohn's disease [34,36], there is no explanation whether pulmonary involvement occurs secondary to the drugs or to the underlying disease process [37]. Intestinal disease activity is considered as the main indicator for the development of pulmonary disease, it's important to the physician possibility for the development of pulmonary disease in patients with Crohn's disease; this is to start the ideal treatment early in order to decrease other further complications [34,37], by undergoing pulmonary evaluation of physical examination, chest X-ray and pulmonary function tests are mandatory in addition to calculate diffuse lung capacity of carbon monoxide to reach a final diagnosis, bronchoscopy and thoracoscopymay be helpful [34]. IBD patients showed impairment of pulmonary function test in some previous studies, whereas other studies do not, and some of them reported that the impairment in pulmonary function test associated with the disease activity, so that there is a recent prospective study carried out by Xiao-Qing Ji in 2016 with an aim of investigating the alterations of pulmonary function tests (PFTs) and their relation with the disease activity in inflammatory bowel diseases, they concluded that PFTs in IBD patients showed subclinical abnormalities some of which could be detected even in the remission periods and become pronounced in the relapse phase of diseases.…”

Eine seltene Ursache pulmonaler Rundherde

“…[1]. Pulmonale Manifestationen von M. Crohn wurden erstmals in den späten 1960er Jahren beschrieben, doch erst Mitte der 1970er Jahre wurden sie in der Literatur allgemein als EIM einer chronisch entzündlichen Darmerkrankung (CED) anerkannt [2][3][4][5]. Eine pulmonale Beteiligung kommt bei M. Crohn nicht häufig vor und wird oftmals überse-hen, insbesondere dann, wenn die respiratorischen Symptome vor Diagnose der gastrointestinalen Manifestationen aufgetreten sind, so wie im vorliegenden Fall.…”