[Relapsing solitary pulmonary nodule in a patient with ulcerative colitis].
BACKGROUND
A 46-year-old patient with ulcerative colitis, known since she was 27 years old, was found to have a mesenteric granulomatous necrotizing inflammation containing acid-fast bacilli ten years ago. Treatment against tuberculosis was initiated. The ulcerative colitis was treated with mesalazin and, in times of peak activity, additionally with prednisolon. During periods of chronic activity the patient received azathioprin. Six years ago a solitary pulmonary nodule (coin lesion) was detected radiologically in the inferior lobe of the left lung.


METHODS
Laboratory investigations revealed mild inflammation (CRP 1.5 mg/dl). Computed tomography showed a solitary nodule in the left lower pulmonary lobe (diameter 27 mm). Fungi, actinomyces and mycobacteria were not found.


METHODS
The pulmonary nodule was resected. During the following years several relapses occurred. After the second relapse lobectomy was performed revealing mycobacterial DNA (not further identified). Treatment against non-tuberculous mycobacteria with clarithromycin, rifampicin and ethambutol was started for 12 months. A third relapse in the form of another solitary pulmonary node occurred one year later. But this nodule regressed spontaneously in part without any additional therapy.


CONCLUSIONS
In this case the spontaneous regression after the third relapse may represent better control of the ulcerative colitis. An infection seems less likely retrospectively.
Kraft
A
A
Pneumologie und Beatmungsmedizin, Thoraxklinik am Universitätsklinikum Heidelberg. alexandra.kraft@thoraxkliniki-heidelberg.de
Kreuter
M
M
Herth
F J F
FJ
Wiebel
M
M
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000995:Antitubercular Agents / Q000627:therapeutic use*; D003093:Colitis, Ulcerative / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D003131:Combined Modality Therapy; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D008168:Lung / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery; D008875:Middle Aged; D011859:Radiography; D012008:Recurrence; D012075:Remission, Spontaneous; D003074:Solitary Pulmonary Nodule / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery
D000900:Anti-Bacterial Agents; D000995:Antitubercular Agents; D007166:Immunosuppressive Agents