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Extra Intestinal Manifestations -
Pulmonary
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Written by Dr Sebastian Zeki
MCQs for this page
Pulmonary
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Patterns of involvement
Percent of total
Respiratory disease
Bronchiectasis 23
Chronic bronchitis 20
Interstitial lung disease 18
Bronchiolitis obliterans with organizing pneumonia (BOOP) 12
Chronic bronchial suppuration 8
Subglottic stenosis 7
Necrobiotic nodules - neutrophilic infiltrates 6
Chronic bronchiolitis 3
Pulmonary infiltrates with eosinophilia 3
Serositis
Pericarditis 36
Pleuropericarditis 31
Myocarditis 24
Pleural effusion 9
Pulmonary complications of IBD
Airway inflammation
—
Inflammation of the trachea, bronchi, and bronchioles can occur in inflammatory bowel disease, with bronchial
involvement being most common.
Bronchiolitis obliterans with organizing pneumonia
(BOOP)
Causes a fever, SOB, cough, and pleuritic chest pain.
CXR: Pleaural based patchiness with air bronchograms.
Primary Respiratory Involvement
This occurs in 40% of IBD patients.
It is more common in UC. Females (2:1). Symptoms develop after onset of IBD.
For pulmonary parenchymal disease — Diffusion capacity is lower during
active IBD.
Drug causing respiratory complications:
Sulfasalazine
—
Pneumonitis,
interstitial lung disease, bronchiolitis
obliterans with organizing pneumonia, and granulomatous lung disease.
5-aminosalicylic acid
—Uncomon- get diffuse or basilar infiltrates, som
-
times with eosinophilia, or may develop bronchiolitis obliterans.
Methotrexate
— Fibrosis.
Azathioprine and 6-mercaptopurine
— Drug-induced hypersensitivity
pneumonitis is rare.
Interstitial lung disease associations:
Sarcoidosis
-
Not a clear association.
Pulmonary infiltrates with eosinophilia (PIE syndrome)
-
is a
complication of sulfasalazine and possible
mesalamine.
Serositis
—show a neutrophil infiltrate.
Pulmonary embolism
.
CXR: Peripheral infiltrates. Get cavtating lung lesions with similar histopath to
Pyoderma
gangrenosum
--Chronic bronchitis or as bronchiectasis.
Generally not responsive to antibiotics.
Bronchiolitis- nonspecific inflammation, narrowing, and fibrosis of small airways; can be granulomatous
-Subglottic inflammation and stenosis - associated with inflammation, friability, and pseudotumors in the
trachea.
Written by Dr Sebastian Zeki
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