Resident Physician The Wright Center for Graduate Medical Education Scranton, Pennsylvania, United States
Introduction: Ulcerative colitis (UC) is a form of inflammatory bowel disease that predominantly affects the colon and rectum. While extraintestinal manifestations like joint, skin, and liver involvement are well-documented, pulmonary complications are considered rare. It is estimated that pulmonary involvement occurs in fewer than 1% of UC patients, making it an uncommon but significant aspect of UC management. These complications can manifest as bronchiolitis, interstitial lung disease, and pleuritis, which are seldom recognized and diagnosed. This case report explores a rare presentation of UC complicated by interstitial lung disease, underscoring the importance of identifying extraintestinal manifestations in patients with chronic inflammatory diseases
Case presentation: A 48-year-old man with a 9-year history of ulcerative colitis presented with progressive shortness of breath, non-productive cough, and intermittent low-grade fever. He had been managing his ulcerative colitis with mesalamine and intermittent corticosteroids but with inconsistent medication adherence. Physical examination revealed rapid breathing and bilateral crackles on auscultation, along with worsening gastrointestinal symptoms. Further tests showed extensive colonic inflammation, bilateral interstitial infiltrates on a chest X-ray, and patchy ground-glass opacities on a high-resolution CT (HRCT) of the lungs, indicating interstitial lung disease (ILD). Pulmonary function tests (PFTs) confirmed a restrictive pattern with reduced diffusing capacity of the lungs for carbon monoxide (DLCO). Bronchoscopy with bronchoalveolar lavage (BAL) ruled out infection and malignancy. The patient was diagnosed with a UC flare complicated by interstitial lung disease. High-dose intravenous corticosteroids were initiated, resulting in the improvement of respiratory and gastrointestinal symptoms. Azathioprine was introduced for long-term immunosuppressive therapy, leading to further improvement. Three months post-discharge, pulmonary function tests showed improvement in DLCO, and follow-up HRCT revealed a reduction in ground-glass opacities.
Conclusion: This case emphasizes the importance of taking into account extraintestinal manifestations, such as rare pulmonary complications, in patients with ulcerative colitis. Early recognition and intervention are crucial for preventing long-term morbidity. This case contributes to the increasing amount of literature showing the connection between ulcerative colitis and interstitial lung disease, underscoring the necessity of a multidisciplinary approach to diagnosis and treatment.
