Multiple Pulmonary Nodules in a Patient with Crohn’s Disease

Abstract

Crohn’s disease (CD) can be associated with respiratory involvement. Multiple pulmonary nodules are an infrequent finding in patients with CD. When they are found, histology usually shows sterile necrobiotic nodules, which are spherical aggregates of neutrophils, which frequently cavitate. We report a patient with inactive CD treated with mesalazine, who presented with multiple pulmonary nodules. Transthoracic biopsy of one of the nodules disclosed a benign, nongranulomatous inflammatory lymphoid infiltration. The radiographic abnormalities responded well to oral prednisone. Focal, nongranulomatous lymphoid infiltration thus must be considered in the differential diagnosis of multiple pulmonary nodules in patients with CD.

Pulmonary Nodules as an Extra-Intestinal Manifestation of Inflammatory Bowel Disease: A Case Series and Review of the Literature

“…Noncaseating epithelioid granulomas are reported and have an association with IBD, particularly CD [4]. Golpe et al reported nongranulomatous lymphoid infiltration as the histopathology of the pulmonary nodule in their case report [6]. On review of the published histology images from Golpe et al by our pathologist who specializes in gastrointestinal and pulmonary pathology, the images were interpreted as interstitial infiltration with a mixture of cells.…”

“…Pulmonary nodules, however, are an uncommon manifestation of IBD with very few documented cases in the English-language literature, as cited in Table 1. Camus et al was one of the earliest authors to propose a link between pulmonary nodules and IBD and other case reports thereafter further solidify the finding of pulmonary nodules as an EIM of IBD [2][3][4][5][6][7][8]. In general, patients with pulmonary nodules related to IBD present with respiratory and constitutional symptoms, but inactive bowel disease.…”

“…The histopathology documented in the literature of pulmonary nodules are mostly of necrobiotic nodules which can be characterized as palisading epithelioid cells surrounding a region of central necrosis [2,4,5,7,8]. However, other histological patterns are described as well and can coexist with necrobiotic lesions, such as heterogeneous, nongranulomatous lymphoid infiltration, bronchiolitis obliterans organizing pneumonia (BOOP), and noncaseating epithelioid granulomas [4][5][6]. Noncaseating epithelioid granulomas are reported and have an association with IBD, particularly CD [4].…”

Pulmonary Necrobiotic Nodules in Crohn's Disease: A Rare Extra-intestinal Manifestation

“…10 Nodular pulmonary amyloidosis associated with Crohn's disease and focal non-granulomatous lymphoid infiltration are other rare causes of lung nodules in Crohn's disease that can mimic necrobiotic lung nodules. 11,12 The small number of reported cases of necrobiotic nodules complicating Crohn's disease do not allow strong conclusions regarding therapy. Of the 4 reported patients, 3 responded to oral prednisone with radiological resolution, and one patient who was maintained on mesalamine at the time of diagnosis had complete radiological resolution with no additional therapy.…”

Thorax as an extraintestinal target for inflammatory bowel disease

“…Treatment with corticosteroids or with appropriate medication such as sulfasalazine or mesalamine for the basic gastrointestinal disease appeared to be satisfactory for both diseases. Pneumonitis, in contrast, due either to sulphasalazine or mesalamine is a well-recognized adverse drug reaction in these patients (19).…”