title: Granulomatous tracheo-bronchitis associated with Crohn's disease.
abstract: We report a rare case of diffuse tracheo-bronchitis as a complication of Crohn's disease. A young man with a long-standing history of Crohn's enterocolitis initially presented with epigastric pain and melena. Upper endoscopy revealed erythematous, edematous, and friable mucosa with erosions, particularly in the pyloric channel, causing gastric outlet obstruction, and a nonbleeding ulcer in the corpus of stomach. Biopsy of these lesions showed chronic gastritis and a noncaseating epithelioid granuloma, consistent with active Crohn's disease. The patient was treated with a course of corticosteroids and the gastric symptoms resolved. A few months later, he developed fever, cough, hemoptysis, and rash. Bronchoscopy demonstrated a markedly thickened and very inflamed trachea with extensive friable, whitish lesions and ulcerations. Histology showed severe noncaseating granulomatous inflammation. The patient improved with a 6-week oral, followed by an additional 4-week inhaled, corticosteroid treatment. Since then, he has been doing well without relapse of pulmonary symptoms for 2 years.
authors.affiliation: Division of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Kai
authors.initials: K
authors.lastname: Xia
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Wolf
authors.forename: Sonia
authors.initials: S
authors.lastname: Friedman
authors.forename: David L
authors.initials: DL
authors.lastname: Carr-Locke
mesh_terms: D000328:Adult; D001991:Bronchitis / Q000150:complications* / Q000473:pathology; D003424:Crohn Disease / Q000150:complications* / Q000473:pathology; D006099:Granuloma / Q000150:complications* / Q000473:pathology; D006801:Humans; D008297:Male; D014136:Tracheitis / Q000150:complications* / Q000473:pathology