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Suzuki A, Noro R, Omori J, Terasaki Y, Tanaka T, Fujita K, Takano N, Sakurai Y, Suga M, Hayashi A, Okamura K, Saito Y, Kasahara K, Iwakiri K, Kubota K, Seike M. Pulmonary manifestation of inflammatory bowel disease: Two case reports. Respir Med Case Rep 2023; 45:101914. [PMID: 37719886 PMCID: PMC10500478 DOI: 10.1016/j.rmcr.2023.101914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 08/22/2023] [Accepted: 08/22/2023] [Indexed: 09/19/2023] Open
Abstract
Pulmonary involvement associated with inflammatory bowel disease (IBD) are a rare extraintestinal manifestation (EIM) of inflammatory bowel disease (IBD), we herein presented two cases. Case 1: 53-year-old man with Crohn's disease treated with mesalazine and azathioprine. Pulmonary nodular shadows were incidentally detected on chest imaging, and revealed granulomas through transbronchial lung biopsy. Case 2: 68-year-old man with ulcerative colitis treated with mesalazine. He presented with fever and respiratory symptoms, and chest imaging showed multiple nodular infiltrates. He was diagnosed with organizing pneumonia by lung biopsy. Both cases were diagnosed to have pulmonary involvement associated with inflammatory bowel disease (IBD) according to multidisciplinary examination including positron emission tomography-computed tomography (FDG-PET) and pathological test. Pulmonary manifestations with IBD may not always require discontinuation of drugs or additional use of steroids or immunosuppressants.
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Affiliation(s)
- Ayana Suzuki
- Department of Respiratory Medicine, Nippon Medical School Hospital, Tokyo, Japan
| | - Rintaro Noro
- Department of Respiratory Medicine, Nippon Medical School Hospital, Tokyo, Japan
| | - Jun Omori
- Department of Gastroenterology and Hepatology, Nippon Medical School Hospital, Tokyo, Japan
| | - Yasuhiro Terasaki
- Department of Pathology, Nippon Medical School Hospital, Tokyo, Japan
| | - Toru Tanaka
- Department of Respiratory Medicine, Nippon Medical School Hospital, Tokyo, Japan
| | - Kazue Fujita
- Department of Respiratory Medicine, Nippon Medical School Hospital, Tokyo, Japan
| | - Natsuki Takano
- Department of Respiratory Medicine, Nippon Medical School Hospital, Tokyo, Japan
| | - Yumi Sakurai
- Department of Respiratory Medicine, Nippon Medical School Hospital, Tokyo, Japan
| | - Miyuri Suga
- Department of Respiratory Medicine, Nippon Medical School Hospital, Tokyo, Japan
| | - Anna Hayashi
- Department of Respiratory Medicine, Nippon Medical School Hospital, Tokyo, Japan
| | - Ken Okamura
- Department of Respiratory Medicine, Nippon Medical School Hospital, Tokyo, Japan
| | - Yoshinobu Saito
- Department of Respiratory Medicine, Nippon Medical School Hospital, Tokyo, Japan
| | - Kazuo Kasahara
- Department of Respiratory Medicine, Nippon Medical School Hospital, Tokyo, Japan
| | - Katsuhiko Iwakiri
- Department of Gastroenterology and Hepatology, Nippon Medical School Hospital, Tokyo, Japan
| | - Kaoru Kubota
- Department of Respiratory Medicine, Nippon Medical School Hospital, Tokyo, Japan
| | - Masahiro Seike
- Department of Respiratory Medicine, Nippon Medical School Hospital, Tokyo, Japan
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Schmid F, Chao CM, Däbritz J. Pathophysiological Concepts and Management of Pulmonary Manifestation of Pediatric Inflammatory Bowel Disease. Int J Mol Sci 2022; 23:7287. [PMID: 35806292 PMCID: PMC9266732 DOI: 10.3390/ijms23137287] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 06/28/2022] [Accepted: 06/28/2022] [Indexed: 02/01/2023] Open
Abstract
Pulmonary manifestation (PM) of inflammatory bowel disease (IBD) in children is a rare condition. The exact pathogenesis is still unclear, but several explanatory concepts were postulated and several case reports in children were published. We performed a systematic Medline search between April 1976 and April 2022. Different pathophysiological concepts were identified, including the shared embryological origin, "miss-homing" of intestinal based neutrophils and T lymphocytes, inflammatory triggering via certain molecules (tripeptide proline-glycine-proline, interleukin 25), genetic factors and alterations in the microbiome. Most pediatric IBD patients with PM are asymptomatic, but can show alterations in pulmonary function tests and breathing tests. In children, the pulmonary parenchyma is more affected than the airways, leading histologically mainly to organizing pneumonia. Medication-associated lung injury has to be considered in pulmonary symptomatic pediatric IBD patients treated with certain agents (i.e., mesalamine, sulfasalazine or infliximab). Furthermore, the risk of pulmonary embolism is generally increased in pediatric IBD patients. The initial treatment of PM is based on corticosteroids, either inhaled for the larger airways or systemic for smaller airways and parenchymal disease. In summary, this review article summarizes the current knowledge about PM in pediatric IBD patients, focusing on pathophysiological and clinical aspects.
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Affiliation(s)
- Florian Schmid
- Catholic Children’s Hospital Wilhelmstift, 22149 Hamburg, Germany;
| | - Cho-Ming Chao
- Department of Pediatrics, University Medical Center Rostock, 18057 Rostock, Germany;
- Cardio-Pulmonary Institute (CPI), University of Giessen and Marburg Lung Center (UGMLC), German Center of Lung Research (DZL), Justus-Liebig-University, 35398 Giessen, Germany
| | - Jan Däbritz
- Department of Pediatrics, University Medical Center Greifswald, 17475 Greifswald, Germany
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