Pulmonary Necrobiotic Nodules in Crohn's Disease: A Rare Extra-intestinal Manifestation

Abstract

Pulmonary necrobiotic nodules represent a rare extra-intestinal manifestation of Crohn's disease. Histologically, they are composed of sterile aggregates of inflammatory cells with necrosis. The differential diagnosis is broad, and exclusion of infectious etiologies is mandatory before starting immunosuppressive therapy. Here, we present the fifth reported case of pulmonary necrobiotic nodules in Crohn's disease. Our patient had new-onset Crohn's disease associated with both cavitating and non-cavitating lung nodules that were confirmed to be necrobiotic nodules by biopsy. The patient was started on mesalamine and prednisone, with subsequent improvement of his gastrointestinal symptoms and regression of the necrobiotic nodules. Key words: pulmonary necrobiotic nodules; Crohn's disease; video-assisted thoracoscopy. [Respir Care 2014;59(12):e190 -e192.

Cavitary lung nodules as an extraintestinal manifestation of ulcerative colitis

“…Drug-induced lung injury from commonly prescribed medications for IBD treatment must always be considered including from methotrexate, anti- tumor necrosis factor (TNF) agents, sulfasalazine and among others 6. Our patient’s pulmonary manifestations began following initiation of infliximab, and therefore, a drug-associated organising pneumonia cannot definitively be excluded.…”

An Infrequent Extraintestinal Manifestation of Ulcerative Colitis: Pulmonary Necrobiotic Nodules

“…Our case describes a rare case of necrobiotic pulmonary nodules in a patient with poorly controlled UC. Necrobiotic nodules are sterile nodules composed of inflammatory cells with necrosis [7]. On imaging, these nodules can appear round and well defined, exhibiting cavitation [5].…”

Necrobiotic Pulmonary Nodules in Ulcerative Colitis: Not Just a “Crohnic” Phenomenon

“…The classical patient developing necrobiotic pulmonary nodules is often a young individual (age <30 years) with a known diagnosis of IBD who presents with respiratory symptoms. 13 – 15 Most cases described in literature reveal the presence of active luminal disease. 10 , 11 Although our patient did fit the reported age bracket and presented with active colitis, he did not present with respiratory symptoms and was thus diagnosed incidentally.…”