Case Report
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World J Gastroenterol. Oct 21, 2012; 18(39): 5653-5657
Published online Oct 21, 2012. doi: 10.3748/wjg.v18.i39.5653
Tracheobronchial nodules and pulmonary infiltrates in a patient with Crohn's disease
De-Gan Lu, Xiao-Qing Ji, Qi Zhao, Cai-Qing Zhang, Zhen-Fang Li
De-Gan Lu, Xiao-Qing Ji, Cai-Qing Zhang, Department of Respiratory Medicine, Shandong Provincial Qianfoshan Hospital, Jinan 250014, Shandong Province, China
Qi Zhao, Zhen-Fang Li, Department of Digestive Medicine, Liaocheng People’s Hospital, Liaocheng 252000, Shandong Province, China
Author contributions: Lu DG and Ji XQ treated the patient and collected the data; Lu DG and Ji XQ wrote the paper; Zhao Q, Zhang CQ and Li ZF revised the paper.
Correspondence to: De-Gan Lu, MD, Professor, Department of Respiratory Medicine, Shandong Provincial Qianfoshan Hospital, 16766th Jingshilu, Lixia District, Jinan 250014, Shandong Province, China. deganlu@126.com
Telephone: +86-531-82968368 Fax: +86-531-82963647
Received: November 21, 2011
Revised: July 26, 2012
Accepted: July 29, 2012
Published online: October 21, 2012
Abstract

Crohn’s disease is a granulomatous systemic disorder of unknown etiology. Obvious pulmonary involvement is exceptional. Tracheal involvement in Crohn’s disease is even more unusual, only a few cases have been reported to date. We herein report a rare case of tracheobronchial nodules and pulmonary infiltrates in both lungs as a complication of Crohn’s disease. A 42-year-old man underwent pancolectomy for multiple broken colon caused by Crohn’s disease. Forty days later pulmonary symptoms and radiologic abnormalities were noted. A search for bacterial (including mycobacteria) and fungal in the repeated sputum proved negative. The treatment consisted of intravenous antimicrobials for one month, but there was no improvement in pyrexia or cough and radiologic abnormalities. Fibreoptic bronchoscopy (FOB) was performed and revealed nodes in the trachea and the right upper lobe opening. Histopathology of tracheobronchial nodules and bronchial mucosa biopsy specimen both showed granulomatous inflammation with proliferation of capillaries and inflammatory cells. Oral steroid and salicylazosulfapyridine were commenced and led to marked improvement in symptoms and an almost complete resolution of his chest radiograph. Repeated FOB showed that nodes in the trachea disappeared and the ones in the right upper lobe opening diminished obviously. Crohn’s disease can be associated with several respiratory manifestations. The form of tracheal and bronchopulmonary involvement in Crohn’s disease is rare and responded well to steroids.

Keywords: Crohn’s disease; Inflammatory bowel disease; Lung; Extracolonic involvement