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Allergy and Airway |

A Case of Progressive Bronchiectasis in a Patient With Ulcerative Colitis

Benjamin Seides*, MD; Kenneth Olivier, MD; Charles Daley, MD; Doreen Addrizzo-Harris, MD
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Division of Pulmonary & Critical Care Medicine, NYU School of Medicine, New York, NY


Chest. 2012;142(4_MeetingAbstracts):7A. doi:10.1378/chest.1360071
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Abstract

SESSION TYPE: Airway Case Report Posters

PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM

INTRODUCTION: Ulcerative colitis (UC) has a rare, but well-documented, association with pulmonary disease. We present a case of a patient with progressive bronchiectasis due to ulcerative bronchitis following colectomy.

CASE PRESENTATION: A female 50 year old former smoker initially presented with new onset UC. Her disease was poorly controlled with immunosuppressive agents, and she underwent a total colectomy. Two years later, she presented with cough, shortness of breath, and wheeze. Obstructive dysfunction was detected and bronchodilator therapy was initiated with partial relief of symptoms. Chest CT was notable for centrilobular nodules, mild bronchiectasis, and peribronchial wall thickening. The patient’s clinical and respiratory status progressively worsened. Sputum cultures grew Mycobacterium avium-complex (MAC), and therapy with clarithromycin, ethambutol, and rifampicin was initiated. Cultures converted negative, but following an initial period of radiographic and clinical improvement, the patient again began to experience increased cough, SOB, sputum production, as well as constitutional symptoms. Inhaled amikacin and hypertonic saline were added to her regimen. The patient’s clinical and respiratory status progressively deteriorated despite clearance of MAC from sputum cultures, and further chest imaging revealed markedly progressed bronchiectasis and bronchial wall thickening with bronchiolitis. Bronchoscopy revealed severe edema, inflammation, and cobblestoning of the trachea and proximal airways. Large and medium airway biopsies showed severe submucosal inflammation, lymphoplasmacytic infiltration, squamous metaplasia, and peribronchial fibrosis. Findings were consistent with ulcerative bronchitis. The patient subsequently underwent wedge resection of her severely bronchiectatic RML. Surgical cultures were negative, and there is a plan to initiate immunosuppressive therapy for treatment of her UC-related lung disease.

DISCUSSION: Pulmonary involvement in UC may involve small and large airways, parenchyma, or serosa. Airway and colonic inflammation in UC are likely mediated by the same mechanism, probably owing to shared embryonic origins. Respiratory symptoms unresponsive to usual therapies may precede diagnosis, and the pulmonary manifestations of UC may progress independently of intestinal disease and occur years after colectomy. Importantly, many drugs which are used to treat UC can induce pulmonary hypersensitivity or toxicity. Treatment of ulcerative bronchitis involves immunosuppressive therapy, usually with glucocorticoids and/or steroid sparing agents. This should only be considered once potentially offending medications have been withdrawn and superimposed infections have been eradicated.

CONCLUSIONS: In patients with UC and unexplained respiratory complaints, consider UC-related pulmonary disease.

1) Black H, et al. Chest 2007;131:524.

2) Storch I, et al. Inflammatory Bowel Disease 2003;9(2):104.

3) Camus P, et al. Medicine 1993:72:151.

DISCLOSURE: The following authors have nothing to disclose: Benjamin Seides, Kenneth Olivier, Charles Daley, Doreen Addrizzo-Harris

No Product/Research Disclosure Information

Division of Pulmonary & Critical Care Medicine, NYU School of Medicine, New York, NY

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