title: Limited granulomatosis with polyangiitis in an adolescent with Crohn's disease on infliximab therapy: cause or coincidence?
abstract: Pulmonary involvement in Crohn's disease (CD) may precede the development of intestinal inflammation, but in most cases occurs during the course of treatment, either as an extra-intestinal manifestation, because of secondary infections, or as a side effect of the therapy itself. This case highlights the differential diagnosis and work up for multiple pulmonary nodules that developed in a patient with CD who had been in remission on infliximab therapy. Even though infectious causes, such as Mycobacteria and Fungi, account for majority of these cases, the possibility of non-infectious conditions such as autoimmune disorders should also be considered.
authors.affiliation: Division of Pediatric Infectious Diseases, Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, USA.
authors.forename: Harbir
authors.initials: H
authors.lastname: Arora
authors.affiliation: Division of Pediatric Gastroenterology, Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, USA.
authors.forename: Shailender
authors.initials: S
authors.lastname: Madani
authors.affiliation: Division of Pediatric Pathology, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, MI, USA.
authors.forename: Larisa V
authors.initials: LV
authors.lastname: Debelenko
authors.affiliation: Division of Pediatric Infectious Diseases, Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, USA.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: McGrath
authors.affiliation: Division of Pediatric Hospitalist Medicine, Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, USA.
authors.forename: Ramakrishna
authors.initials: R
authors.lastname: Mutyala
authors.affiliation: Division of Pediatric Pulmonary Medicine, Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, USA.
authors.forename: Lokesh
authors.identifier: http://orcid.org/0000-0001-8145-0430
authors.initials: L
authors.lastname: Guglani
mesh_terms: D061605:Administration, Intravenous; D003424:Crohn Disease / Q000188:drug therapy*; D003937:Diagnosis, Differential; D005260:Female; D014890:Granulomatosis with Polyangiitis / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D000069285:Infliximab / Q000009:adverse effects / Q000627:therapeutic use*; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects; D013256:Steroids / Q000008:administration & dosage / Q000009:adverse effects; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D013256:Steroids; D000069285:Infliximab; D008727:Methotrexate
keywords: Crohn's disease; adverse effects; granuloma; inflammatory bowel disease; infliximab; lung biopsy; lung disease; pulmonary nodules; tumor necrosis factor