Tracheitis – A Rare Extra-Intestinal Manifestation of Ulcerative Colitis in Children

Abstract

IntroductionInflammatory bowel disease may cause both intestinal and extraintestinal manifestations. Respiratory symptoms in ulcerative colitis are rare and tracheal involvement is exceedingly rare in children.Case 1Sixteen year-old female with a 4-week-complaint of abdominal pain, bloody diarrhea, fever and cough. The investigation was consistent with the diagnosis of concomitant ulcerative colitis/coinfection to Escherichia coli. On day 4 respiratory signs persisted so azithromycin and inhaled corticosteroids were added. By day 6 she progressed to respiratory failure and was diagnosed with necrotic tracheitis so started on intravenous steroids with fast clinical improvement.Case 2Twelve-year-old male adolescent with ulcerative colitis and sclerosing cholangitis started dry cough and throat pain 10 days after diagnosis. Laboratory investigations showed increased inflammatory signs and normal chest X-ray. He started treatment with azithromycin without clinical improvement and on day five he presented dyspnea and fever. Laryngeal fibroscopy suggested tracheitis and so systemic steroids where added with fast clinical and analytic improvement.DiscussionTracheitis should be suspected if there are persistent respiratory symptoms even when exams are normal. Early recognition and early treatment are essential for a good prognosis preventing progression to respiratory failure.

Necrotizing Tracheitis Complicated by Tracheal Wall Perforation

“…13 Non-infectious causes of necrotizing tracheitis that have been reported include endotracheal intubation and inflammatory bowel disease. [14][15][16] Necrotizing tracheitis causes persistent airway inflammation and tissue friability, increasing the risk for emergent complications such as airway obstruction and tracheal perforation, both of which were seen in this case. Successful management of this patient's airway required a multidisciplinary discussion.…”

“…13 Non-infectious causes of necrotizing tracheitis that have been reported include endotracheal intubation and inflammatory bowel disease. 14-16…”

The Important Role of Endoscopy in Management of Pediatric Pseudomembranous Necrotizing Tracheitis

“…Opportunistic infection occurs in immunosuppressed patients such as those with hematologic malignancies, organ transplantation, or neutropenia (7). Pseudomembranous necrotizing tracheitis can also be a rare extra-intestinal manifestation of ulcerative colitis in children (8). This disease should be differentiated from acute laryngitis, epiglottitis, foreign body inhalation, and obstructive fibrinous tracheal pseudomembrane (9).…”