S2243 Reversal Obstructive Lung Disease in Ulcerative Colitis: A Rare Extraintestinal Manifestation

Abstract

INTRODUCTION: Ulcerative colitis (UC) is associated with several extraintestinal manifestations that may affect various organ systems, lungs involvement are relatively rare. Our case highlights a patient presenting with symptoms of reversible obstructive airway disease associated with UC disease activity. CASE DESCRIPTION/METHODS: A 23 YO male with history of Ulcerative pancolitis presented to Virginia Commonwealth University (VCU)-IBD Center with unresolving cough, wheezing, diarrhea, fecal urgency and abdominal pain. Physical exam was notable for moderate abdominal tenderness and minimal lung wheeze. Lab data reveled elevated CRP of 14 mg/dL and fecal calprotectin of 1285 µg/gm. CT abdomen/pelvis revealed active inflammation with diffuse colonic wall thickening. UC Treated initially with Mesalamine after diagnosis at age of 22 YO, combination therapy with Adalimumab and Methotrexate started few weeks prior to presentation.Pulmonary symptoms were manifested in cough and wheezing. These symptoms were exacerbated with worsening UC activity and more responsive to steroids courses. CT chest was negative for interstitial lung disease. Prior pulmonary function test (PFT) showed mild obstructive airway disease requiring albuterol and corticosteroids inhalers. He was found to have infectious colitis causing UC flare. GI and pulmonary symptoms improved with therapy optimization, steroids and methotrexate were stopped. Clinical remission were maintained with Adalimumab monotherapy. He remained off respiratory inhalers. Subsequent PFT with improved lung volumes and function. DISCUSSION: The prevalence and pathogenesis of lung involvement in IBD is poorly understood but it may be related to the underlying inflammatory process. Respiratory manifestations of ulcerative colitis are rare, they can be broadly categorized into airway disease and interstitial lung disease. These manifestations usually follow the IBD disease activity and often exacerbate during relapses. Patients with airway disease can have significant airway inflammation, which could potentially lead to airway narrowing. The most common presenting symptoms include cough and wheezing. Chest radiographs are often non-specific and pulmonary function testing may reveal obstruction pattern. CT scan of the chest may not show remarkable findings.This case report highlights that it is imperative to maintain a high index of suspicion for the development of pulmonary disease in the setting of IBD in order to institute appropriate treatment early and avoid complications.