Pulmonary Migratory Infiltrates and Pachypleuritis in a Patient with Crohn’s Disease

Abstract

Crohn’s disease can be associated with several respiratory manifestations. We report here a case of pulmonary migratory infiltrates associated with bilateral pleural thickening and peripheral eosinophilia. The histopathological findings show an association of necrotizing nodules, eosinophilic infiltration in the non-abscessed lung tissue, areas of non-caseating epithelioid granulomas, and an extensive pleural fibrosis. The different histopathological findings are detailed and the responsibility of either Crohn’s disease or treatment by mesalazine is discussed.

Organizing Pneumonia: A Rare Extra Intestinal Manifestation of Ulcerative Colitis

“…Nevertheless, it is more frequent in ulcerative colitis than Crohn's disease [1,4,8]. It is often one-sided exudates effusion.…”

“…No difference has been noted between clinical presentation of OP secondary to IBD and other systemic disease. The specific histological feature is characterized by polypoid endobronchial connective tissue masses composed of myxoid fibroblastic tissue resembling granulation tissue filling the lumens of the terminal and respiratory bronchioles and extending in a continuous fashion into alveolar ducts and alveoli, representing an organizing pneumonia [8,9]. a b It is essential to rule out infection as the main cause for pulmonary disease especially in patients who are under immunosuppressant.…”

“…Even though this medication has been proven to be efficient in cutaneous, ocular, articular and hepatic disease due to IBD [14,15], few studies have identified its benefits on respiratory manifestations. Casey et al [8] reported 4 cases of patients with OP including only one patient treated successfully with infliximab.…”

Pulmonary necrobiotic nodules: a rare extraintestinal manifestation of Crohn's disease

“…Since that report there have been small series but mostly isolated case reports. A spectrum of pulmonary involvement has been described, including: 1) airway disease (tracheal [4] and tracheobronchial [5] stenosis, tracheobronchitis [6], bronchitis [3], bronchiectasis [7], bronchiolitis [8] and asthma [9]); 2) interstitial lung disease (granulomatous alveolitis [10], bronchiolitis obliterans with organising pneumonia [11], interstitial fibrosis [12] and lung infiltrates with peripheral eosinophilia [13]); and 3) serositis (pleural thickening [12] and pleuropericarditis [13]). …”

“…Including the case presented herein, only four cases have been described and are summarised in table 1. The first reported patient was a 38-yr-old female with a 3-yr history of Crohn's disease, with recurrent bronchitis and mucopurulent sputum, migratory lung infiltrates with peripheral eosinophilia and bilateral pleural thickening, who was treated with mesalazine [12]. Histopathological examination revealed necrotising nodules, eosinophilic infiltration of the nonabscessed tissue and areas of noncaseating epithelioid granulomas.…”