Tracheobronchial nodules and pulmonary infiltrates in a patient with Crohn＇s disease

• Published in: 世界胃肠病学杂志：英文版 2012, Vol.18 (39), p.5653-5657
• Main Author: De-Gan Lu Xiao-Qing Ji Qi Zhao Cai-Qing Zhang Zhen-Fang Li
• Format: Article
• Language: English
• Subjects: 全身性疾病; 支气管; 浸润; 激素治疗; 组织病理学; 细胞增殖; 结核; 肺部
• ISSN: 1007-9327; 2219-2840

Crohn＇s disease is a granulomatous systemic disorder of unknown etiology. Obvious pulmonary involvement is exceptional. Tracheal involvement in Crohn＇s disease is even more unusual, only a few cases have been report- ed to date. We herein report a rare case of tracheobron- chial nodules and pulmonary infiltrates in both lungs as a complication of Crohn＇s disease. A 42-year-old man underwent pancolectomy for multiple broken colon caused by Crohn＇s disease. Forty days later pulmonary symptoms and radiologic abnormalities were noted. A search for bacterial （including mycobacteria） and fungal in the repeated sputum proved negative. The treatment consisted of intravenous antimicrobials for one month, but there was no improvement in pyrexia or cough and radiologic abnormalities. Fibreoptic bronchoscopy （FOB） was performed and revealed nodes in the trachea and the right upper lobe opening. Histopathology of tracheo- bronchial nodules and bronchial mucosa biopsy speci- men both showed granulomatous inflammation with proliferation of capillaries and inflammatory cells. Oral steroid and salicylazosulfapyridine were commenced and led to marked improvement in symptoms and an almost complete resolution of his chest radiograph. Repeated FOB showed that nodes in the trachea disappeared and the ones in the right upper lobe opening diminished ob- viously. Crohn＇s disease can be associated with several respiratory manifestations. The form of tracheal and bronchopulmonary involvement in Crohn＇s disease is rare and responded well to steroids.