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home - IBD - Extra Intestinal Manifestations - Pulmonary Written by Dr Sebastian Zeki


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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