Crohn’s disease is a one of the inflammatory bowel diseases pathologically associated with granulomas. Crohn’s disease may involve extra- intestinal organs but lung involvement is extremely uncommon and multiple pulmonary nodules are extremely rare. We are reporting a case of young female with nultiple pulmonary nodules due to Crohn’s disease which completely responded to steroids.
21 years old, non smoker, African American female presented with pleuritic chest pain for 2 months. She was diagnosed with Crohn’s disease 4–5 years ago and had been treated with Salfasalzine. For the last 1 year she was not receiving treatment as she was pregnant and delivered a baby month ago. Chest x-ray was performed which showed diffuse, ill-defined, nodular type opacity in right lower lobe. CT scan examination of chest showed multiple pulmonary nodules in bilateral lung fields ranging from 1–3 cm in largest diameter. Differential diagnosis included pulmonary nodules associated with Crohn’s disease, pulmonary nodules due to salfasalzine therapy, pulmonary nodules due to atypical infections particularly MAC and pulmonary nodules due to reactive amyloidosis along with usual causes of lung nodules. Bronchoscopy with BAL was negative for any infectious etiologies. Finally, an open lung biopsy was performed and revealed well-formed granuloma composed of epithelioid histiocytes, lymphocytes and giant cells. There was no eosinophilia which is characteristic of lung nodules due to salfasalzine. Lung nodules due to Crohn’s disease was considered as final diagnosis. She was treated with steroids and symptomatically improved completely. Chest x-ray after 2 years showed complete resolution of nodular opacity.
Lung nodules due to Crohn’s disease is extremaly rare extra intestinal manifestation of Crohn’s Disease. There are only 10–15 cases have been reported. I our pateint complete resolution and clinical improvement was noted.
In case of lung nodules in pateint with Inflammatory Bowel Diseases (IBD)several differential diagnosis are possible including salfasalzine induced reactive lung nodules in which case eosinophilia is important feature. Granuloma composed of pallets of epithelioid histiocytes is characteristic of lung nodules caused by IBD itself. Steroid is usual treatment with dramatic response.
Bhavinkumar Dalal, No Financial Disclosure Information; No Product/Research Disclosure Information