Thorax as an extraintestinal target for inflammatory bowel disease (original) (raw)

Inflammatory bowel disease (IBD) is a chronic and relatively common disorder of uncertain etiology (1). IBD can be associated with a variety of respiratory disorders (2). A link between pulmonary disease and IBD was suggested nearly 40 years ago (3). Both screening studies and the cumulative volume of case reports suggest that respiratory system may be involved in IBD more frequently than it is generally appreciated (4). The colonic and respiratory epithelia both share embryonic origin from the primitive foregut (5). Although, many of the reported pulmonary diseases associated with IBD have cryptic etiologies, the causes or mechanisms of respiratory tract involvement in IBD remain poorly understood (2). A 51 years old female patient was admitted to our clinic with the complaints of cough, fever and sputum production for 10 days and abdominal pain, bloody stool and diarrhea for two days. The patient was a lifelong non-smoker and had no history of occupational or environmental exposure relevant to lung disease. Despite empirical antibiotic treatment, there was no clinical improvement. Chest X-ray revealed infiltration at the right lower zone. Pulmonary function test was normal. Connective tissue markers including ANA, anti-dsDNA, RF were negative. Erytrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were high. Contrast-enhanced computed tomography revealed segmental atelectasis on the right lower lobe and infiltration around atelectasis (Figure 1). A bronchoscopy was performed; there was endobronchial polypoid lesion on the posterior wall of the posterior segment of right lower lobe. Bronchoscopic biopsy revealed subepithelial fibrosis and under the 312