SESSION TITLE: ILD Student/Resident Case Report Posters
SESSION TYPE: Medical Student/Resident Case Report
PRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PM
INTRODUCTION: Inflammatory bowel disease (IBD), which includes Crohn’s disease (CD) and ulcerative colitis, is a chronic inflammatory condition primarily associated with the gastrointestinal tract. Pulmonary extra-intestinal manifestations (EIM) are considered rare manifestations of IBD despite increasing evidence suggesting frequent pulmonary involvement. Despite increasing awareness and knowledge, little is known about its treatment other than steroid therapy. Infliximab, a chimeric monoclonal antibody with affinity for tumor necrosis factor alpha, is routinely used for the treatment of moderate and severe IBD. We present a case of CD with pulmonary EIM treated with Infliximab and a literature review.
CASE PRESENTATION: A 33-year-old obese male presented with a six week history of cough, clear sputum production, non-bloody diarrhea and unintentional weight loss. CT scan of chest, abdomen and pelvis revealed terminal ileum thickening and stranding with lymphadenopathy and scattered bilateral cavitary nodules with lymphadenopathy (Image 1). Subsequent colonoscopy revealed Crohn’s Disease. After referral to pulmonology, bronchoscopy revealed intra-alveolar macrophages, bronchitis and no malignant cells. T-spot and Mantoux screening test were negative. Cultures including bacterial, fungal, and acid-fast were negative. Serologic evaluation including HIV 1/2 antibody, anti-neutrophil cytoplasmic antibodies, urinary and serum histoplasma antigen, cryptococcus antibody, galactomannan and beta-D-glucan assay were all negative. Initially started on prednisone and mesalamine with improvement in diarrhea but the lung disease persisted. The patient was diagnosed with pulmonary EIM of IBD and started on Infliximab with both clinical and radiological resolution of pulmonary disease.
DISCUSSION: The prevalence of IBD is approximately 396/100,000 or 1.4 million Americans. In general, pulmonary EIM are identified in 30-60% of cases. Steroids have been the mainstay of treatment used in about 65% of cases; however, up to 1/3 of patients fail treatment. Infliximab therapy has been shown to be efficacious in other EIM’s. When infliximab use for pulmonary EIM was explored only eight cases were discovered (Table 1).
CONCLUSIONS: We present a case of CD with pulmonary EIM successfully treated with Infliximab. With review of the literature demonstrating possible efficacy, we would advocate Infliximab as a therapeutic alternative to corticosteroids in pulmonary EIM of IBD until appropriate randomized controlled trials can be performed.
Reference #1: Black et al., Thoracic manifestations of inflammatory bowel disease. Chest 131, 524-532 (2007).
Reference #2: Pedersen et al., Pulmonary Crohn’s disease: A rare extra-intestinal manifestation treated with infliximab. J Crohns Colitis 3, 207-211 (2009).
Reference #3: Rutgeerts et al., Review article: Infliximab therapy for inflammatory bowel disease--seven years on. Aliment. Pharmacol. Ther. 23, 451-463 (2006). 72.
DISCLOSURE: The following authors have nothing to disclose: Adam Hayek, Heath White
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