Tracheo-bronchitis as a complication of Crohn's disease —A case report—

Abstract

A case of Crohn's enterocolitis associated with diffuse tracheo-bronchitis is presented herein. Although respiratory tract involvement in Crohn's disease is extremely rare, our review of the world literature revealed several common clinical pathologic features. These features include a productive cough with chest X-ray films which are normal except for some peripheral involvement. Bronchoscopy, however, shows diffuse inflammation of the trachea and bronchi with widely scattered whitish lesions while biopsy reveals a granulomatous infiltration of inflammatory cells. This tracheobronchitis typically responds well to treatment with prednisone.

Acute respiratory failure due to tracheobronchial involvement in Crohn's disease

“…Colonic biopsies disclosed superficial ulcerations with tuberculoid granulomas. In 1991 IWANA et al [9] reported one case of tracheobronchial localization in a 25 year old man, occurring 10 yrs after a total colectomy for CD. Bronchoscopy also revealed whitish granulations and biopsies showed squamous cell metaplasia of the bronchial epithelium and inflammatory cell infiltration, without granulomas.…”

“…The temperature was 38˚C. Laboratory data at admission showed the following abnormalities: white blood cell counts 21.4×10 9 On Day 4, the patient continued to exhibit dry cough and diarrhoea. Colonoscopy was performed and revealed small petechiae confined to the sigmoid colon, without other abnormality.…”

“…However, few cases of lung involvement in CD have previously been reported [1], such as granulomatous interstitial pneumonitis [2][3][4], fistula [5], bronchiectasis [6] and sulphasalazine-induced pneumonitis [7]. Among these manifestations, bronchial and/or tracheal localizations are very rare [8,9]. We report the case of a patient with diffuse tracheal and bronchial localizations of CD leading to respiratory failure.…”

Alterations in the pulmonary function tests of inflammatory bowel diseases

“…Several respiratory diseases, such as small and large airway disorders (1,2), obstructive and interstitial lung diseases (3), increase in bronchial sensitivity (4), bronchitis, bronchiectasis (5)(6)(7)(8), inflammatory tracheal stenosis (9), interstitial pneumonitis (10), and bronchiolitis obliterans (11)(12)(13) have been reported in patients with IBD. However, information about the types and incidence of respiratory disorders associated with IBD are insufficient.…”

Thorax as an extraintestinal target for inflammatory bowel disease

“…Respiratory system may be affected from upper airway to alveoli. The large airways are the most common location of IBD involvement (2,12,13). Stridor may be a presenting symptom due to subglottic inflammation and stenosis.…”