Diffuse Lung Disease: Diffuse Lung Disease |

Cryptogenic Organizing Pneumonia and Asymptomatic Pulmonary Cryptococosis Coexisting in a Patient With Crohn's Disease FREE TO VIEW

Li Zhou, MD; Ruoyun Ouyang, PhD; Yating Peng, PhD
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The Second Xiangya Hospital of Central-South University, Changsha, China

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A189. doi:10.1016/j.chest.2016.02.196
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SESSION TITLE: Diffuse Lung Disease

SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, April 17, 2016 at 11:45 AM - 12:45 PM

INTRODUCTION: Crohn’s disease (CD) is a chronic granulomotous illness associated with a number of extraintestinal manifestations that may involve most organ systems. Cryptogenic organizing pneumonia (COP), a type of organizing pneumonia without the presence of evident pathogens, is a relatively rare extraintestinal manifestation of Crohn's disease (CD). Besides, it may be easy for the patient who is under anti-TNFα therapy to develop some opportunistic infections such as fungal infection, especially in older patients.

CASE PRESENTATION: A 66-year-old patient with Crohn’s disease visited our hospital because of dyspnea and productive cough for one month. Combination with clinical findings, computed tomography (CT) and lung pathological histology, he was diagnosed with Cryptogenic organizing pneumonia (COP) and pulmonary cryptococosis (PC) eventually, which are both relatively rare extraintestinal manifestation of Crohn‘s disease (CD). And the patient was treated with prednisone. However, what makes us surprised is that the patient did not have any symptoms or CT features of fungal infection, not to mention the environmental contamination to Cryptococcus. Considering that hormone may exacerbate fungal infections, the treatment of fluconazole was also given. The follow-up CT scan 2 months after treatment showed almost complete resolution in the lung.

DISCUSSION: There are no cases describing COP and PC occurring in CD meanwhile1. In our present case, the clinical symptoms, the CT scan abnormalities, the lung histology, the clinical course and the response to corticosteroid treatment were strongly suggestive of COP. Nevertheless, it is important for us to know that COP may be caused by drugs employed in the treatment of CD, such as mesalazine and azathioprine2. What’s more, it is generally accepted that opportunistic infections in CD such as PC3, often occur in patients who are under the treatment of immunosuppressive medications. The patient had no symptoms or imaging manifestations of PC. So whether fluconazole should be given became a dilemma.

CONCLUSIONS: Case such this, the coexistent pulmonary manifestation occurring in Crohn’s disease, brought us some clinical thinking. Most of time, the clinical manifestations are untyptical. So how to recognize, differentiate and diagnose them timely remains a difficult challenge. Dealing with CD patients who complait with tough respiratory symptoms, earlier histopathology may be necessary.

Reference #1: Dinneen HS, Samiullah S, Lenza S. Cryptogenic organizing pneumonia: a rare extra-interstinal manifestation of Crohn's disease. J Crohns Cotilis 2014 Feb;8(2):177-8.

Reference #2: Foster RA, Zander DS, Mergo PJ, Valentine JF. Mesalamine-related lung disease: clinical, radiographic, and pathologic manifestations. Inflamm Bowel Dis 2003;9:308-15.

Reference #3: Hirai F, Matsui T, Ishibashi Y, et al. Asymptomatic pulmonary cryptococcosis in a patient with Crohn's disease on infliximab: case report. Inflamm Bowel Dis. 2011 Jul;17(7):1637-8.

DISCLOSURE: The following authors have nothing to disclose: Li Zhou, Ruoyun Ouyang, Yating Peng

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