Pulmonary Crohn Research Articles

Pulmonary Crohn's Disease or Crohn's Disease with Lung Sarcoidosis? A Case Report and Literature Review.

Crohn's disease and ulcerative hemorrhagic colitis are forms of granulomatous inflammatory intestinal disease, which usually affects the gastrointestinal tract. There are also reported rare localizations at the skin, kidney, joints, liver and eye level. Pulmonary involvement is relatively rare, and it is most commonly reported in suppuration with bronchiectasis. On the other hand, sarcoidosis is, in principle, a thoracic localization of a granulomatosis disease, although bowel, skin and intestinal disorders are described. There is not a clear line to separate Crohn's disease from sarcoidosis with, possibly because they are, in fact, considered to have the same inflammatory granulomatosis disease pathology. The diagnoses of the two entities, sarcoidosis and Crohn's disease, are based on non-pathognomonic, inclusive clinical and paraclinical criteria, without elements of the mutual exclusion of typical locations. We present a very rare case of a young male, already diagnosed with small-bowel Crohn's disease. Granulomatous lung disease with major hemoptysis requires emergency surgery. An intraoperative assessment revealed a necrotic hemorrhagic lesion located in the left lower lobe and a lobectomy was performed. The final pathological report showed the presence of non-caseous granulomatous inflammation, with the identification of specific multinucleated giant cells. The identical diagnostic principles of Crohn's disease and sarcoidosis, Crohn's disease as a predecessor to pulmonary lesions, the clinical picture and the necrotico-hemorrhagic appearance of the unilateral pulmonary lesion, which are similar to aggressive necrotico-hemorrhagic or perforating intestinal forms, are arguments in favor of the diagnosis of pulmonary Crohn's disease and not pulmonary sarcoidosis. At the same time, in general, the two diseases have overlapping elements, suggesting they are, in fact, not the same disease with different facets.

S2286 An Encouraging Case of Pulmonary Crohn's Disease

S2286 An Encouraging Case of Pulmonary Crohn's Disease

Case of a 38 Year Old Male with Pulmonary Crohn's Disease

We present the case of a 38 year old male who presented with several weeks of respiratory complaints found to be the result of Crohn's Disease (CD) with Pulmonary Manifestations. His past medical history was significant for long standing CD and he was on immunosuppressive therapy with vedolizumab. Initial findings were concerning for Bronchopneumonia or a possible Metastatic Disease. Subsequent work-up eliminated infectious and cancerous etiologies. This included blood cultures, HIV, Quantiferon Gold Assay, PPD, and bronchial biopsy results. Furthermore, GMS, AFB, and Truant special stains were negative for fungal elements and mycobacteria. Eventually, the patient underwent a VATS (video-assisted thoracoscopic surgery) biopsy, which revealed noncaseating granulomas with prominent neutrophilic microabscesses. This finding led to the differential diagnosis of either a vasculitis, or a pulmonary CD. The lack of cavitation, fibrinoid necrotizing epithelioid and eosinophilic granulomas, necrotizing granulomatous vasculitis, glomerulonephritic symptoms, and a negative ANCA essentially ruled out the diagnosis of eosinophilic granulomatosis with polyangiitis. Biopsy of the lung also did not reveal the characteristic geographic necrosis and acute and chronic inflammation changes which are typical of granulomatosis with polyangiitis. These findings ultimately led to the diagnosis of Pulmonary CD with pulmonary necrobiotic nodules. This is an extremely rare manifestation of the Inflammatory Bowel Syndrome and one that clinicians should have within their differential upon treating patients with long-standing CD and pulmonary complications.

Pulmonary Crohn's disease: A rare extra-intestinal manifestation treated with infliximab

Crohn's disease is a chronic inflammatory bowel disease often presenting with extra-intestinal manifestations. However, pulmonary involvement is quite rare. We report a case of Crohn's disease with pulmonary extra-intestinal manifestation (bronchiolitis obliterans organizing pneumonia-like changes) treated with infliximab. Furthermore, we present an overview of cases of inflammatory bowel disease with lung involvement, treated with tumor necrosis factor-α antagonists. In this case, when infliximab was given, a significant resolution of the pulmonary changes was achieved.

Treatment of Pulmonary Crohnʼs Disease with Infliximab

Purpose: Three teenage patients, previously diagnosed with gastrointestinal Crohn's disease developed severe pulmonary symptoms requiring hospitalization. The Purpose of this investigation is to describe the clinical outcome of their pulmonary disease following treatment with Infliximab. Methods: All three patients had their gastrointestinal symptoms well controlled on combinations of medical therapy that included 6-mercaptopurine, mesalamine, and/or steroids. All 3 patients had chest x-rays that showed diffuse pulmonary infiltrates. One patient had a left-sided pleural effusion. Results: CT scans confirmed the radiographic findings. Open lung biopsies in 2 patients showed non-necrotic, non-caseating granulomas consistent with pulmonary Crohn's disease. The other patient had evidence of organizing pneumonia. The 2 patients with pulmonary granulomas were treated initially with infliximab (5 mg/kg) that resulted in rapid improvement of respiratory symptoms within 3 days. The patient with organizing pneumonia was treated with high-dose steroids and intravenous broad spectrum antibiotics and after 2 weeks showed no significant improvement. He was subsequently treated with infliximab (5 mg/kg) that resulted in an equally rapid improvement of his respiratory symptoms. All patients were discharged from the hospital within 3 days of these infusions and all received repeat infliximab infusions at 2 and 6 weeks following the initial infusion and every 8 weeks thereafter. At the present time the follow-up, which ranges from 1 to 18 months, has shown all 3 patients to be free of all respiratory symptoms. Conclusions: Pulmonary involvement, rarely reported in the pediatric population, has been identified in patients with Crohn's disease. Infliximab therapy, which is well-tolerated, may be the drug of choice for these patients.

Pulmonary Crohn’s disease (CD)

Pulmonary Crohn’s disease (CD)