SESSION TYPE: Pleural Cases I
PRESENTED ON: Tuesday, October 23, 2012 at 11:15 AM - 12:30 PM
INTRODUCTION: Inflammatory bowel disease can affect airways and parenchyma of lung as first reported by Kraft. Rarely does it involve the pleura and pericardium causing recurrent serositis. (1)
CASE PRESENTATION: In this report we describe a 49 year old female with history of Crohn’s disease who presented with chest pain, pleurisy and SOB. On physical examination, she was afebrile, tachycardic and hypotensive. The breath sounds were decreased at the lung bases. The abdomen was tender to palpation in the upper quadrants, without peritoneal signs. The laboratory data revealed normal blood counts and a negative autoimmune and infectious panel. The chest radiograph demonstrated small bilateral pleural effusions and a CAT scan of her chest/abdomen revealed moderate sized pericardial effusion, fluid filled distal small bowel loops and small bilateral pleural effusions. A TTE revealed a large pericardial effusion and early tamponade. A therapeutic pericardiocentesis was performed and exudative, sterile neutrophil predominant fluid was drained. A diagnostic thoracentesis revealed a neutrophil predominant sterile effusion. She was readmitted multiple times with pleurisy and pericardial tamponade and eventually underwent pericardiectomy, the pathology of which revealed fibrosis and chronic inflammation with lymphoid aggregates. As no definite etiology was identified, the recurrent effusions were attributed to Crohn’s disease. The patient was started on prednisone which resolved the pleuritis.
DISCUSSION: Thoracic Serositis in patients with IBD can cause pleuritis, pericarditis, pleuropericarditis or myopericarditis. Although these respiratory symptoms develop in patients at any time in the history of the IBD, most do so following the onset of bowel disease by days to decades. The reason for the wide range of time-to-onset of the respiratory disease is unknown, as are the reasons why only few patients develop the disease. The respiratory manifestations are unusual as they may develop in the quiescent phase. Although the specific pathophysiology of this remains unclear, the response to systemic steroids is usually adequate similar to our patient.
CONCLUSIONS: In conclusion, Serositis is an uncommon extraintestinal complication which should be considered in the differential diagnosis of IBD patients presenting with similar symptoms. Such manifestations are probably underrecognized and underreported due to the routine use of anti-inflammatory drugs in the acute and maintenance management of IBD.
1) Kraft SC, Earle RH, Rossler M, Estarly JR. Unexplained bronchopulmonary disease with inflammatory bowel disease. Arch intern Med 1976; 136: 454-459.
2) Camus Ph, Plard F, Ashcraft T, Gal AA, Colby TV. The lung in inflammatory bowel disease. Medicine (Blatimore) 1993; 72:151-183.
3) Muhanned Abu-Hijleh, Samuel Evans, Bassam Aswad. Pleuropericarditis in a Patient with Inflammatory Bowel Disease: A Case Presentation and Review of the Literature. Lung (2010) 188:505-510.
DISCLOSURE: The following authors have nothing to disclose: Sowjanya Duthuluru
No Product/Research Disclosure InformationUniversity of Kansas Medical Center, Kansas City, KS