(P070) RARE PULMONARY MANIFESTATIONS IN A PATIENT WITH CROHN’S DISEASE

Introduction: Pulmonary complications in Crohn's disease (CD) are infrequent but can manifest in various respiratory pathologies, including bronchiolitis, interstitial lung disease (ILD), and bronchiolitis obliterans with organizing pneumonia (BOOP). The connection between Crohn's disease and pulmonary involvement is not well understood, making it an under-recognized yet significant complication. This case report presents a rare occurrence of BOOP in a patient with Crohn’s disease. 

Case Presentation: A 36-year-old female with an 11-year history of Crohn's disease sought medical attention due to a persistent dry cough, progressive shortness of breath, and intermittent fever over the past four months. Her Crohn’s disease had been effectively managed with infliximab, and she denied any recent worsening of gastrointestinal symptoms. She had no history of smoking, known allergies, or recent infections. Upon physical examination, bilateral crackles were detected upon auscultation of the lungs. Laboratory studies, including blood cultures, sputum analysis, and autoimmune panels, revealed no significant findings. A high-resolution CT (HRCT) scan of the chest displayed widespread ground-glass opacities and bilateral patchy consolidations, which were suggestive of BOOP. Pulmonary function tests (PFTs) indicated a mild restrictive defect. A bronchoalveolar lavage (BAL) was performed, and tests for bacterial, viral, and fungal infections came back negative. Histopathological analysis of a transbronchial lung biopsy confirmed the diagnosis of BOOP, characterized by granulation tissue obstructing small airways and alveolar ducts. Given the patient's history of Crohn’s disease and the exclusion of other potential causes, BOOP was considered a rare extraintestinal manifestation of Crohn’s disease. The patient was initiated on high-dose corticosteroids (prednisone 40 mg daily), leading to significant improvement in her respiratory symptoms within two weeks. Infliximab treatment was continued for her underlying Crohn’s disease. Over three months, follow-up imaging revealed the resolution of lung opacities, and the corticosteroid dose was gradually tapered. 

Conclusion: Pulmonary manifestations in Crohn’s disease are uncommon and not fully understood, with an estimated prevalence of 0.2% to 0.5%. BOOP, also known as cryptogenic organizing pneumonia (COP), is a rare inflammatory lung condition that has been observed in patients with Crohn's disease. This case emphasizes the infrequent incidence of BOOP in a patient with Crohn’s disease, emphasizing the necessity for early recognition and proper management of pulmonary complications in IBD. Timely treatment with corticosteroids can lead to favorable outcomes, and clinicians should maintain a high index of suspicion for pulmonary involvement when Crohn's patients present with respiratory symptoms.