Pulmonary manifestations of inflammatory bowel disease: Case presentations and review

Abstract

Inflammatory bowel disease (IBD) is associated with a number of extraintestinal manifestations that may involve most organ systems. Extraintestinal manifestations are more common in Crohn disease (CD) and may include rheumatologic, ocular, dermatologic, biliary and pulmonary manifestations. The most common pulmonary manifestations of IBD are drug-induced lung disease. Other manifestations include parenchymal disease, pleuritis and overlap syndromes. We present a case series of 7 patients with non-infectious pulmonary manifestations of IBD, which included cryptogenic organizing pneumonia, usual interstitial pneumonitis (UIP), Langerhan's granulomatosis, and eosinophilic pneumonia. Concurrent extraintestinal manifestations present in these patients included arthralgia, iritis, and pyoderma gangrenosum. In most patients the development of pulmonary disease parallels that of the intestinal disease activity, extraintestinal manifestations and concurrent use of 5-ASA medications.

Lung disease and ulcerative colitis − mesalazine-induced bronchiolitis obliterans with organizing pneumonia or pulmonary manifestation of inflammatory bowel disease?

“…Parenchymal disease is another less frequent pulmonary involvement in IBD with a female predominance. The most common condition is bronchiolitis obliterans organizing pneumonia (BOOP [26]. Less common interstitial manifestations, i. e., pulmonary interstitial emphysema syndrome, desquamative interstitial pneumonia (DIP), non-specific interstitial pneumonia (NSIP), fibrosing alveolitis, eosinophilic pneumonitis or necrobiotic pulmonary nodules are rare findings in patients with IBD [21,25].There are few descriptions of pleuritis and pericarditis in association with IBD but without correlation to gastrointestinal symptoms and disease activity.…”

“…Many conditions respond to corticosteroid treatment, in mild cases of airway involvement inhaled steroids have been reported to be sufficient. Few cases report treatment with other immunosuppressive agents such as infliximab, cyclosporine, azathioprine or mycophenolate mofetilin patients with failing steroid response [2, 26,31].…”

Rheumatologic and extraintestinal manifestations of inflammatory bowel diseases

“…It should be highlighted that some pulmonary manifestations of IBDs are related to IBD treatment. Sulfasalazine and mesalazine have been associated with eosinophilic pneumonia and with pleural effusions and pulmonary fibrosis (35).…”

Clinical and paraclinical guidelines for management of sulfur mustard induced bronchiolitis obliterans; from bench to bedside

“…Common causes of BO include previous childhood infections (particularly measles, adenovirus and Mycoplasma), toxic inhalation, graft-versus-host disease following bone marrow transplantation, chronic rejection following a lung or heart-lung transplant and autoimmune connective tissue disorders such as rheumatoid arthritis treated with penicillamine therapy (Skeens et al, 1989;Müller & Miller, 1995;Heng et al, 1998;Scott et al, 2005). Other conditions have also more recently been linked with BO such as ulcerative colitis (Basseri et al, 2010), hyperplasia and tumoral proliferation of peripheral neuroendocrine cells in the lungs (Myers et al, 2009). It is also a relatively frequent complication of cystic fibrosis following repeated lung infections (Nash et al, 2012).…”