Baton Rouge General Medical Center Baton Rouge, LA, United States
Melissa Bunke, MD, Jeremy Polman, DO, MS, MBA, John Godke, MD Baton Rouge General Medical Center, Baton Rouge, LA
Introduction: Pulmonary pathology is considered to be the least common extra-intestinal manifestation (EIM) of inflammatory bowel disease (IBD). Pulmonary involvement typically manifests as a chronic productive cough, dyspnea, and rarely, airway stenosis. Here, the authors present a rare case of an obstructing pulmonary mass in a patient with ulcerative colitis (UC).
Case Description/Methods: A 35-year-old female with a past medical history of UC presented to her primary care provider with persistent cough, low-grade fever, and body aches for 1 week. She described her UC as in remission with maintenance mesalamine monotherapy. She was diagnosed with community acquired pneumonia (CAP) after chest x-ray (CXR) demonstrated left lower lobar consolidation. She was given a 7-day course of antibiotics. Despite therapy, the patient showed clinical decline and was admitted to the hospital for further therapy. Further evaluation revealed a white blood cell count of 6600/mL, erythrocyte sedimentation rate of 87 mm/h, and c-reactive protein of 12 mg/L. CT chest showed bilateral upper lobe and lingular patchy consolidations, and a 12mm x 13mm x 6mm soft tissue structure at the bifurcation of the upper and lower lobe bronchi, obstructing the left mainstem bronchus. During bronchoscopy, the left mainstem bronchus demonstrated circumferential airway thickening, which caused approximately 50% luminal diameter narrowing and areas of white eschar. Biopsies demonstrated acute and chronic inflammation, no granulomatous inflammation or malignant cells. Given hemodynamic stability, patient was discharged the following day with a 3-month prednisone taper with initial dose of 60mg/day. On repeat bronchoscopy 6 weeks later, the left mainstem bronchus had significant improvement in obstruction with residual luminal narrowing. At 6-month follow up bronchoscopy, mild residual hyperemia and slight focal luminal narrowing remained within the left mainstem without evidence of thickening.
Discussion: The relationship between IBD and associated respiratory EIMs is surprising. One theory is based on the similar embryological origin of the airways and the gastrointestinal tract. Some EIMs are closely linked to disease activity and relative flare-ups while others are present during clinical remission. Respiratory manifestations do not seem to have a clear relationship with the stage of bowel disease severity or activity. Thus, this case demonstrates the importance of considering pulmonary EIMs of IBD in patients with clinical remission.
Disclosures: Melissa Bunke indicated no relevant financial relationships. Jeremy Polman indicated no relevant financial relationships. John Godke indicated no relevant financial relationships.
Melissa Bunke, MD, Jeremy Polman, DO, MS, MBA, John Godke, MD. P2704 - A Gut Feeling: A Case of an Obstructing Pulmonary Mass Related to Inflammatory Bowel Disease, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.