Journal List > Tuberc Respir Dis > v.62(1) > 1001115

TOOLS
Noh, Baik, Ryu, Kim, Lee, Sim, Lee, and Chun: A Case of Nonspecific Interstitial Pneumonia in a Patient with Ulcerative Colitis
Case Report
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2007; 62(1): 56-61.

Published online: 31 January 2007

DOI: https://doi.org/10.4046/trd.2007.62.1.56

A Case of Nonspecific Interstitial Pneumonia in a Patient with Ulcerative Colitis

Young Wook Noh, M.D., Eun Kyung Baik, M.D., Yon Ju Ryu, M.D., Seong-Eun Kim, M.D., Jin Hwa Lee, M.D., Sung Shin Sim, M.D.1, Shi Nae Lee, M.D.2, Eun Mi Chun, M.D.

Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea.

1Department of Radiology, College of Medicine, Ewha Womans University, Seoul, Korea.

2Department of Pathology, College of Medicine, Ewha Womans University, Seoul, Korea.

Address for correspondence: Eun Mi Chun, M.D. Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Dongdaemun Hospital, Ewha Womans University, College of Medicine, Jongno 6-ga, Jongno-Ku, Seoul, Republic of Korea. Phone: (02) 760-5053, Fax: (02) 760-5193, cem@ewha.ac.kr

Received 26 October 2006       Accepted 28 December 2006

Copyright © 2007 The Korean Academy of Tuberculosis and Respiratory Diseases

Abstract

Pulmonary complications of ulcerative colitis are relatively uncommon and may present as a variety of disorders. Ulcerative colitis-related interstitial lung disease is extremely rare. There are a few case reports of nonspecific interstitial pneumonia in ulcerative colitis worldwide but none in Korea. We report a patient with ulcerative colitis related biopsy-proven nonspecific interstitial pneumonia, who responded to prednisolone (1 mg/kg) and mesalazine therapy.

Keywords: Nonspecific interstitial pneumonia, Ulcerative colitis

Figures and Tables

Figure 1
Initial Chest PA shows bilateral multifocal ill-defined peripheral dominant consolidations, nodules and reticular opacities (A). Chest PA after 3 months shows improvement of the lesions (B).
trd-62-56-g001
Figure 2
Lung window of transaxial enhanced CT (1.25-mm collimation) scans done at initial diagnosis, where aortic arch level (A) and right bronchus intermedius level (B) shows irregular shaped nodules, reticular lesions and both upper lobe consolidation with subpleural area (arrows). Lung window scan obtained after 3 months treatment on same level (A) and (B) demonstrating decrease of previous noted (C, D) lesions.
trd-62-56-g002
Figure 3
Colonoscopic finding shows diffuse erythematous lesions, loss of vascular markings, and fine granular inflammatory lesions, with exudates from rectum to cecum (A-C). Colonoscopic finding repeated after treatment shows interval improvement (D-F) of the lesions.
trd-62-56-g003
Figure 4
Histologic findings of open lung biopsy. These microscopic findings show mild to moderate chronic interstitial inflammation, containing lymphocytes and a few plasma cells, in a uniformed pattern. Patchy interstitial fibrosis without temporal heterogeneity is present with a few airspace organization. These features are consistent with nonspecific interstitial pneumonia, mixed type (cellular and fibrosing types). (H&E Stain, ×100, A and B)
trd-62-56-g004
Figure 5
Histologic findings of colonscopic biopsy. Microscopic findings show chronic inflammation with prominent lymphoid aggregates and crypt abscess (H&E Stain, ×400).
trd-62-56-g005

References

1. Rankin GB. Extraintestinal and systemic manifestations of inflammatory bowel disease. Med Clin North Am. 1990. 74:39–50.
2. Chikano S, Sawada K, Ohnishi K, Fukunaga K, Tanaka J, Shimoyama T. Interstitial pneumonia accompanying ulcerative colitis. Intern Med. 2001. 40:883–886.
3. Eade OE, Smith CL, Alexander JR, Whorwell PJ. Pulmonary function in patients with inflammatory bowel disease. Am J Gastroenterol. 1980. 73:154–156.
4. Higenbottam T, Cochrane GM, Clark TJ, Turner D, Millis R, Seymour W. Bronchial disease in ulcerative colitis. Thorax. 1980. 35:581–585.
5. Moles KW, Varghese G, Hayes JR. Pulmonary involvement in ulcerative colitis. Br J Dis Chest. 1988. 82:79–83.
6. Kraft SC, Earle RH, Roesler M, Esterly JR. Unexplained bronchopulmonary disease with inflammatory bowel disease. Arch Intern Med. 1976. 136:454–459.
7. Rickli H, Fretz C, Hoffman M, Walser A, Knoblauch A. Severe inflammatory upper airway stenosis in ulcerative colitis. Eur Respir J. 1994. 7:1899–1902.
8. Yoo MK, Lee JH, Han SB, Jeon YJ, Cho SC. A case of interstitial lung disease in ulcerative colitis. Tuberc Respir Dis. 1997. 44:1140–1145.
9. Rogers BH, Clark LM, Kirsner JB. The epidemiologic and demographic characteristics of inflammatory bowel disease: an analysis of a computerized file of 1400 patients. J Chronic Dis. 1971. 24:743–773.
10. Williams T, Eidus L, Thomas P. Fibrosing alveolitis, bronchiolitis obliterans, and sulfasalazine therapy. Chest. 1982. 81:766–768.
11. Kemler BJ, Alpert E. Inflammatory bowel disease associated circulating immune complexes. Gut. 1980. 21:195–201.
12. Martinet Y, Rom WN, Grotendorst GR, Martin GR, Crystal RG. Exaggerated spontaneous release of platelet-derived growth factor by alveolar macrophages from patients with idiopathic pulmonary fibrosis. N Engl J Med. 1987. 317:202–209.
13. Fujita J, Ohtsuki Y, Yoshinouchi T, Yamadori I, Bandoh S, Tokuda M, et al. Idiopathic non-specific interstitial pneumonia: as an "autoimmune interstitial pneumonia". Respir Med. 2005. 99:234–240.
14. Camus P, Piard F, Ashcroft T, Gal AA, Colby TV. The lung in inflammatory bowel disease. Medicine. 1993. 72:151–183.
15. Karadag F, Ozhan MH, Akcicek E, Gunel O, Alper H, Veral A. Is it possible to detect ulcerative colitisrelated respiratory syndrome early? Respirology. 2001. 6:341–346.
TOOLS
Similar articles