Bilateral Pulmonary Embolism in a Hospitalized Ulcerative Colitis Patient

Pulmonary manifestation of inflammatory bowel disease: Two case reports

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.

COVID-19 Vaccination Associated Bilateral Pulmonary Embolism: Cause or Coincidence

Background

Acute pulmonary embolism (APE) is a common cause of morbidity and mortality all over the world. Sudden onset dyspnea and chest pain are characteristic. Prior to our index case, only two previous cases of bilateral pulmonary thromboembolism were reported in black Africans and the first to be associated with COVID-19 vaccination. These cases were seen and described in middle-aged men. Case Summary. A 59-year-old man presented with a 2 week history of sudden onset dyspnea and a week history of productive cough. No associated chest pain or hemoptysis. No preceding history suggestive of leg pain/swelling. The patient had the booster dose of moderna (mRNA) COVID-19 vaccine a month before the onset of symptoms. There was associated anorexia, generalized body pain, joint pain, and weakness. He had reduced oxygen saturation at presentation with tachycardia. CTPA showed nearly occlusive right and left pulmonary arteries.

Conclusion

Bilateral acute pulmonary embolism is rare all over the world. Its association with COVID-19 vaccine administration is even rarer. However, the clinical presentations and investigation findings are similar to the descriptions available in the literature for unilateral APE.