[Granulomatous pulmonary involvement preceding diagnosis of Crohn disease: a pediatric case report]

Cutaneous Vasculitis, Interstitial Pneumonia with Crazy-Paving Appearance, and Positive pANCA in a Patient with Severe Crohn's Disease

Cutaneous vasculitis, interstitial pneumonia with crazy-paving appearance on high-resolution computed tomography, and repeated positive perinuclear anti-neutrophil cytoplasmic antibodies (pANCA) are rarely found together in patients with inflammatory bowel disease in the existing literature. We report the case of a Chinese patient previously diagnosed with cutaneous vasculitis and interstitial pneumonia, who presented with acute pain and mass in his right lower quadrant a couple of years later. The terminal ileum biopsy and postoperative pathology confirmed Crohn's disease (CD).

Pulmonary manifestations of Crohn’s disease

Crohn’s disease (CD) is a systemic illness with a constellation of extraintestinal manifestations affecting various organs. Of these extraintestinal manifestations of CD, those involving the lung are relatively rare. However, there is a wide array of lung manifestations, ranging from subclinical alterations, airway diseases and lung parenchymal diseases to pleural diseases and drug-related diseases. The most frequent manifestation is bronchial inflammation and suppuration with or without bronchiectasis. Bronchoalveolar lavage findings show an increased percentage of neutrophils. Drug-related pulmonary abnormalities include disorders which are directly induced by sulfasalazine, mesalamine and methotrexate, and opportunistic lung infections due to immunosuppressive treatment. In most patients, the development of pulmonary disease parallels that of intestinal disease activity. Although infrequent, clinicians dealing with CD must be aware of these, sometimes life-threatening, conditions to avoid further impairment of health status and to alleviate patient symptoms by prompt recognition and treatment. The treatment of CD-related respiratory disorders depends on the specific pattern of involvement, and in most patients, steroids are required in the initial management.

Pulmonary and hepatic nodular lesions precede the diagnosis of Crohn's disease in an 8-year-old girl: a case study and review of the literature

AIM

To describe a novel clinical observation and to provide a review the literature about lung involvement in children with Crohn disease (CD).

METHODS

An 8-year-old girl presented with pulmonary and hepatic granulomatous lesions, followed 6 months later by abdominal and general symptoms, resulting in the diagnosis of CD. Differential diagnosis between CD and sarcoidosis and a review of the literature about lung lesions in children with CD are discussed.

RESULTS

Crohn disease can be associated with pulmonary lesions, developing before, at the same time or after occurrence of digestive symptoms.

CONCLUSIONS

This report highlights not only the importance of looking for lung lesions in CD but also underscores the necessity of considering the diagnosis of CD in incomplete presentation evoking sarcoidosis.