Pulmonary necrobiotic nodules: a rare extraintestinal manifestation of Crohn's disease

Abstract

The present article reports the case of a 22-yr-old female with new onset Crohn's colitis, anterior uveitis and multiple pulmonary nodules which, on histological examination, were necrobiotic nodules. This is a rare but recognised pulmonary extraintestinal manifestation of Crohn's disease and only the fourth reported case. The present case report is followed by a brief review of the relevant literature.

Extraintestinal Manifestations of Ulcerative Colitis

“…Patients usually present with high fever and constitutional symptoms. The lesions show PMNs and fibrin with necrosis, a similar pattern seen in PG, a dematologic complication of IBD (Camus, Piard et al, 1993;Warwick et al, 2009). Chest X-ray can show multiple cavitary and noncavitary nodules.…”

Respiratory System Involvement in Inflammatory Bowel Diseases

“…One of possible radiological presentations of pulmonary involvement in the course of IBD are lung nodules, sometimes with cavitations within them [43,[56][57][58][59][60][61]. Histopathological verification of such findings has revealed the following: necrobiotic nodules composed of sterile aggregates of neutrophils containing areas of necrosismost frequently, bronchiolitis obliterans with organizing pneumonia, noncaseating epithelioid granulomas, heterogeneous lymphoid infiltrations, interstitial fibrosis and deposits of amyloid A component.…”

“…All these medications, with the exception of glucocorticosteroids, are well known for their possible lung toxicity [62][63][64][65][66][67][68][69][70][71]. The assumed lung-toxicity manifests itself mostly as interstitial lung diseases such as eosinophilic pneumonia, organizing pneumonia, interstitial lung fibrosis, interstitial pneumonia with nonnecrotizing granulomas, not specified interstitial pneumonia, bronchiolitis [60][61][62][63][64][65][66][67][68][69]. Rarely drug--induced toxicity manifests itself as pleuritis [72][73][74].…”

“…The spontaneous resolution of the pulmonary nodules was also seen in few patients. Resolution, either spontaneous or during treatment, was very slow in some cases [43,[56][57][58][59][60][61].…”

Introducing the newEuropean Respiratory Review

“…In a new feature for the Review, I am very keen to publish case reports, in order to highlight specific aspects of the theme under discussion; I also encourage the submission of more comprehensive case reviews and case series on subjects that will be of interest to the respiratory community. There are two such case reports presented in the present issue of the European Respiratory Review: one detailing a rare pulmonary manifestation of Crohn's disease, presented by WARWICK et al [5], and another by MONTANI et al [6] on fatal rupture of pulmonary arteriovenous malformation in pulmonary arterial hypertension complicating hereditary haemorrhagic telangiectasia. Of course, the Review will continue to publish sponsored material, providing coverage of symposia and workshops organised around topics relevant to the theme.…”