title: A case presentation of a pulmonary complication of ulcerative colitis.
abstract: We present the case of a 25-year-old Afro-Caribbean man with a longstanding history of ulcerative colitis and primary sclerosing cholangitis. The patient presented to clinic and reported pleuritic-type chest pain. A routine chest radiograph requested from the clinic revealed an incidental right middle zone opacity in the right lung. A subsequent high-resolution CT showed multiple lung nodules. The patient also had a positive cytoplamic anti-neutrophil cytoplasmic antibody (cANCA) and proteinase 3 antibodies. Bronchoscopy was inconclusive. A video-assisted thoracoscopic surgery biopsy was then taken. The histology revealed changes suggestive of bronchiolitis obliterans organising pneumonia. The pulmonary manifestations of inflammatory bowel disease are poorly characterised. Our literature search has revealed cases hypothesising that immune system dysregulation could display pulmonary complications of ulcerative colitis. The aetiology is thought to be related to the treatment with mesalazine. However, our patient also had a positive vasculitic screen. Previous cases have resolved with supportive management or steroid therapy.
authors.affiliation: Department of Respiratory Medicine, Birmingham Heartlands Hospital, Birmingham, UK. ambitalwar@googlemail.com
authors.forename: Ambika
authors.initials: A
authors.lastname: Talwar
authors.forename: Heinke
authors.initials: H
authors.lastname: Kunst
authors.forename: Theodore
authors.initials: T
authors.lastname: Ngatchu
authors.forename: Simon
authors.initials: S
authors.lastname: Trotter
mesh_terms: D000328:Adult; D003093:Colitis, Ulcerative / Q000150:complications*; D018549:Cryptogenic Organizing Pneumonia / Q000209:etiology*; D006801:Humans; D008297:Male