Tracheobronchitis in a Patient with Crohn's Disease

Asami, Takashi; Koyama, Shinichiro; Watanabe, Yasutaka; Miwa, Chihiro; Ushimaru, Shinya; Nakashima, Yoshiyuki

doi:10.2169/internalmedicine.48.1999

Cited by 16 publications

(14 citation statements)

References 6 publications

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“…Although bronchial dilation was attempted in that case, the procedure resulted in tracheal rupture and death (8). While gastrointestinal and respiratory symptoms were relieved simultaneously in most cases (9,13), the clinical courses of the upper airway and digestive diseases were not always entirely parallel (17). For example, in one case, the patient's respiratory status improved markedly with corticosteroid therapy, whereas the exacerbation of UC worsened, resulting in emergency colectomy for toxic megacolon (7).…”

Section: Discussionmentioning

confidence: 99%

Tracheobronchitis with Dyspnea in a Patient with Ulcerative Colitis

et al. 2015

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We herein report the case of a 42-year-old man with a one-year history of ulcerative colitis who presented with exacerbated bloody diarrhea, a productive cough and increasing breathing difficulties. Colonoscopy revealed typical deep ulcers in the rectosigmoid colon and atypical multiple sucker-like ulcers in the transverse colon, and computed tomography of the chest demonstrated wall thickening of the trachea and bronchi. In addition, bronchoscopy showed ulcers in the trachea, and histopathology disclosed findings of necrosis and inflammation of the subepithelial tissue of the trachea. Based on these findings, the patient's respiratory symptoms were strongly suspected to be due to ulcerative colitis-related tracheobronchitis. Treatment with systemic corticosteroids subsequently resulted in a rapid clinical improvement.

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Section: Discussionmentioning

confidence: 99%

Tracheobronchitis with Dyspnea in a Patient with Ulcerative Colitis

et al. 2015

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“…We describe the first case in Korea of tracheobronchial involvement in CD, which is rare even globally. Since Kraft et al [ 5 ] reported bronchopulmonary involvement in inflammatory bowel disease in 1976, only 13 cases including the present case (seven men and six women, ages 18 to 59 years; average age, 28 years) [ 3 ] have been reported, and the patient in our case is the youngest ( Table 1 ).…”

Section: Discussionmentioning

confidence: 67%

“…In the present case, as in previous cases, the pathologic findings of the bronchial biopsy were epithelial and subepithelial infiltrates of diverse types of inflammatory cells including neutrophils, macrophages, lymphocytes, and plasma cells [ 2 , 6 , 9 , 13 , 14 ]. According to Asami et al [ 3 ], bronchoscopic and pathologic findings such as these indicate that tracheobronchial inflammation results from the activation of macrophages and T lymphocytes, as does colonic inflammation. Previous reports also suggest that a common antigen triggers mucosal immune responses in both the GI tract and airway [ 2 , 6 , 9 , 13 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…Crohn disease (CD) is a chronic inflammatory disease that mainly affects the gastrointestinal (GI) tract. It may also have various extraintestinal manifestations such as uveitis, arthritis, pyoderma gangrenosum, erythema nodosum, episcleritis, sclerosing cholangitis, and hemolytic anemia [ 1 - 3 ]. Symptomatic tracheobronchial involvement is not common, although CD with chronic bronchitis [ 4 ], bronchiectasis [ 4 , 5 ], upper airway obstruction [ 6 , 7 ], granulomatous interstitial pneumonitis, bronchiolitis obliterans [ 4 ], granulomatous lung disease [ 4 , 8 , 9 ], and interstitial lung disease [ 10 ] has been reported.…”

Section: Introductionmentioning

confidence: 99%

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Tracheal Involvement in Crohn Disease: the First Case in Korea

Park

Kim

et al. 2016

Clin Endosc

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Respiratory involvement in Crohn disease (CD) is rare condition with only about a dozen reported cases. We report the first case of CD with tracheal involvement in Korea. An 18-year-old woman with CD was hospitalized because of coughing, dyspnea, and fever sustained for 3 weeks. Because she had stridor in her neck, we performed computed tomography of the neck, which showed circumferential wall thickening of the larynx and hypopharynx. Bronchoscopy revealed mucosal irregularity, ulceration, and exudates debris in the proximal trachea, and bronchial biopsy revealed chronic inflammation with granulation tissue. Based on these findings, we suspected CD with tracheal involvement and began administering intravenous methylprednisolone at 1 mg/kg per day, after which her symptoms and bronchoscopic findings improved.

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“…In refractory cases procedures like laser beam, balloon dilatation, stent placement or tracheotomy may be necessary to maintain patent airway. 10 , 11 , 12 , 13 , 20 , 21 , 22 , 23 , 24 According to our experience, in the first case the girl had evolution to respiratory failure in spite of inhaled corticosteroid therapy. This highlights the fact that inhaled administration may not be efficient enough in severe cases.…”

Section: Discussionmentioning

confidence: 79%

Tracheitis – A Rare Extra-Intestinal Manifestation of Ulcerative Colitis in Children

Nunes

Abreu

Corujeira

et al. 2016

GE Portuguese Journal of Gastroenterology

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IntroductionInflammatory bowel disease may cause both intestinal and extraintestinal manifestations. Respiratory symptoms in ulcerative colitis are rare and tracheal involvement is exceedingly rare in children.Case 1Sixteen year-old female with a 4-week-complaint of abdominal pain, bloody diarrhea, fever and cough. The investigation was consistent with the diagnosis of concomitant ulcerative colitis/coinfection to Escherichia coli. On day 4 respiratory signs persisted so azithromycin and inhaled corticosteroids were added. By day 6 she progressed to respiratory failure and was diagnosed with necrotic tracheitis so started on intravenous steroids with fast clinical improvement.Case 2Twelve-year-old male adolescent with ulcerative colitis and sclerosing cholangitis started dry cough and throat pain 10 days after diagnosis. Laboratory investigations showed increased inflammatory signs and normal chest X-ray. He started treatment with azithromycin without clinical improvement and on day five he presented dyspnea and fever. Laryngeal fibroscopy suggested tracheitis and so systemic steroids where added with fast clinical and analytic improvement.DiscussionTracheitis should be suspected if there are persistent respiratory symptoms even when exams are normal. Early recognition and early treatment are essential for a good prognosis preventing progression to respiratory failure.

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Tracheobronchitis in a Patient with Crohn's Disease

Abstract: Abstract

Cited by 16 publications

References 6 publications

Tracheobronchitis with Dyspnea in a Patient with Ulcerative Colitis

Tracheobronchitis with Dyspnea in a Patient with Ulcerative Colitis

Tracheal Involvement in Crohn Disease: the First Case in Korea

Tracheitis – A Rare Extra-Intestinal Manifestation of Ulcerative Colitis in Children

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