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KEY WORDS: pulmonary; Crohn's disease; infliximab, extraintestinal manifestations.
Crohn's disease is a chronic inflammatory disorder commonly involving the gastrointestinal tract. However, Crohn's disease may also have several extraintestinal manifestations, such as pyoderma gangrenosum, erythema nodosum, polyarthritis, episcleritis, pericholangitis, and thromboembolism. Pulmonary involvement, although rare, has also been reported in association with inflammatory bowel disease.
We report a patient with Crohn's ileocolitis who presented with multiple pulmonary nodules on chest radiograph, nonproductive cough, and shortness of breath. The diagnosis of pulmonary Crohn's disease was established by histological examination of the pulmonary nodule following open lung biopsy. The patient was treated with infliximab infusion with a successful clinical outcome and radiographic resolution.
CASE REPORT
A 66-year-old female was hospitalized with shortness of breath and palpitations. She also complained of mild nonproductive cough for the past several weeks. She denied any history of chest pain, fever, or hemoptysis. There was no history of paroxysmal nocturnal dyspnea or pedal edema. She was diagnosed with Crohn's ileocolitis three years ago, when she presented with abdominal cramps and diarrhea. At that time, computed tomography of the abdomen showed thickening of the terminal ileum and ascending colon. Upper gastrointestinal and small bowel series showed nodularity and thickening of the terminal ileum suggestive of Crohn's ileitis. Colonoscopy with distal ileum visualization revealed mucosal edema, nodularity, and ulceration involving the terminal ileum, cecum, and ascending colon. Granuloma and chronic inflammatory cells infiltrating the entire mucosa were noted in the biopsies of the ileum and cecum. She was treated initially with oral corticosteroids. However, she suffered debilitating insomnia and mood changes with steroid treatment and was therefore placed on slow-released mesalamine 4 g/day (Pentasa, Hoecht, Kansas City, Missouri, USA). She subsequently presented with pyoderma gangrenosum and polyarthritis involving the knees, elbows, and metacarpophalangeal joints. Rheumatological investigations including rheumatoid arthritis factor and anti-nuclear antibody were negative. Since the patient had moderately severe disease with extraintestinal manifestations and intolerance to corticosteroid therapy, infliximab (5 mg/kg) infusion was given with resolution in arthritis, pyoderma gangrenosum, and gastrointestinal symptoms.
Her past medical history was significant for carcinoma of the breast for which she underwent right mastectomy, coronary artery disease with angioplasty, and ablation therapy for paroxysmal supraventricular tachycardia. Physical examination on this admission revealed tachycardia with heart...