Tracheobronchitis as an Initial Presentation of Ulcerative Colitis

Abstract

We describe a patient with ulcerative colitis (UC) and the rare extraintestinal manifestation of fulminant tracheobronchitis. A 50-year-old man presented with respiratory compromise and bloody diarrhea. His evaluation showed large airway inflammation with fibrinopurulent debris and colonic inflammation and ulcerations consistent with UC. The etiology for the pulmonary pathology was thoroughly investigated and was thought to be an extraintestinal manifestation of the UC.

Tracheobronchitis with Dyspnea in a Patient with Ulcerative Colitis

“…This condition is a rare pulmonary complication of UC, with only 16 reported cases, including the present case (nine men (1,(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). In most of these cases, pulmonary involvement and colonic exacerbation developed simultaneously, as in our patient, whereas tracheobronchitis developed after colectomy in a few cases (8,10,11) or after UC remission of more than 30 years (1,15).…”

“…Tracheobronchitis is characterized by the presence of submucosal inflammation of large airways and the proliferation of the reserve cell layer (7), usually as a result of viral or bacterial infection with underlying lung disease (7). This condition is a rare pulmonary complication of UC, with only 16 reported cases, including the present case (nine men (1,(6)(7)(8)(9)(10)(11)(12)(13)(14)(15).…”

“…The colonic and bronchial epithelia may exhibit a common inflammatory response, as both tissues are derived from the primitive gut (5). Therefore, any part of the respiratory system may be involved in airway-associated diseases, such as subglottic-glottic stenosis, tracheitis, tracheobronchitis, chronic bronchitis, bronchiectasis and pulmonary disorders, including bronchiolitis with organizing pneumonia, interstitial lung disease and serositis (6,7).…”

“…While gastrointestinal and respiratory symptoms were relieved simultaneously in most cases (9,13), the clinical courses of the upper airway and digestive diseases were not always entirely parallel (17). For example, in one case, the patient's respiratory status improved markedly with corticosteroid therapy, whereas the exacerbation of UC worsened, resulting in emergency colectomy for toxic megacolon (7).…”

Extraintestinale Manifestationen bei chronisch-entz�ndlichen Darmerkrankungen*

“…Eine CED kann sich aber auch mit einer pulmonalen Beteiligung manifestieren [8,12,45,53,68,85,98,143,164,178]. symptoms of inflammatory bowel diseases.…”