Ulcerative Tracheobronchitis Years After Colectomy for Ulcerative Colitis

Vasishta, Sanjeev; Wood, John B.; McGinty, Frank

doi:10.1378/chest.106.4.1279

Cited by 33 publications

(15 citation statements)

References 6 publications

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“…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). The relationship between smoking and IBD is well established (16), although the role of smoking in the onset of pulmonary manifestations of IBD remain unclear.…”

Section: Discussionmentioning

confidence: 73%

“…A wide variety of bronchoscopic findings have been reported, including severe tracheal narrowing, erythematous, irregular and ulcerated mucosa (13), a cobblestone appearance (14) and exuberant pus (11). Active inflammation with marked lymphoplasmacytic infiltration within the epithelium and lamina propria without evidence of granuloma formation are typical histopathological findings (15).…”

Section: Discussionmentioning

confidence: 99%

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Tracheobronchitis with Dyspnea in a Patient with Ulcerative Colitis

et al. 2015

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We herein report the case of a 42-year-old man with a one-year history of ulcerative colitis who presented with exacerbated bloody diarrhea, a productive cough and increasing breathing difficulties. Colonoscopy revealed typical deep ulcers in the rectosigmoid colon and atypical multiple sucker-like ulcers in the transverse colon, and computed tomography of the chest demonstrated wall thickening of the trachea and bronchi. In addition, bronchoscopy showed ulcers in the trachea, and histopathology disclosed findings of necrosis and inflammation of the subepithelial tissue of the trachea. Based on these findings, the patient's respiratory symptoms were strongly suspected to be due to ulcerative colitis-related tracheobronchitis. Treatment with systemic corticosteroids subsequently resulted in a rapid clinical improvement.

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Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Tracheobronchitis with Dyspnea in a Patient with Ulcerative Colitis

et al. 2015

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“…UC has been associated with upper airway stenosis [2], tracheobronchitis [3,4], bronchiectasis [5±10], constrictive bronchiolitis [3], panbronchiolitis [11], necrobiotic nodules [8], lung bullae [12], interstitial lung disease [13,14], bronchiolitis obliterans organizing pneumonia (BOOP) [15], sarcoidosis [16], pulmonary vasculitis [17,18], pulmonary eosinophilia [8], Wegener's granulomatosis without renal involvement [19] and apical fibrosis [20].…”

mentioning

confidence: 99%

Clinical and radiological characteristics of lung disease in inflammatory bowel disease

et al. 2000

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The pulmonary associations of inflammatory bowel disease (IBD) are poorly characterized. The clinical, physiological and high-resolution computed tomographic thorax characteristics of the lung disease in patients with IBD presenting with respiratory symptoms are described.Detailed clinical information was obtained and standard pulmonary physiological tests and thorax high-resolution computed tomography performed on 14 patients with ulcerative colitis (UC) and three with Crohn's disease (CD), 10 male, aged 38±83 yrs.Respiratory symptoms had been present for 2±50 yrs and extraintestinal manifestations were present in three (17.6%). Normal pulmonary physiology (six patients) was associated with the high resolution computed tomographic changes of bronchiectasis, mosaic perfusion and air trapping suggestive of obliterative bronchiolitis and a pattern of centrilobular nodules and branching linear opacities ("tree in bud" appearance) suggestive of either cellular bronchiolitis or bronchiolectasis with mucoid secretions. Bronchiectasis was found in 13 patients (11 UC, 2 CD), 11 had air trapping and five had a "tree in bud" appearance on computed tomography. One patient had a predominantly peripheral reticular pattern at the lung bases similar to that found in cryptogenic fibrosing alveolitis and one patient had a mixed reticular and groundglass pattern in the midzones with a patchy distribution in the central and peripheral portions of the lungs with air trapping. Eleven patients (three with alveolitis) exhibited a clinical and/or physiological response to steroids.Pulmonary abnormalities in ulcerative colitis and Crohn's disease can present years after the onset of the bowel disease and can affect any part of the lungs. Early recognition is important as they can be strikingly steroid-responsive. Eur Respir J 2000; 15: 41±18. The presence of subclinical disease in patients without respiratory symptoms was suggested in one study because result of abnormal pulmonary function found in 38% of UC patients and 54% of CD patients, significantly greater pro-portions than in a healthy control populations [27].Pul-monary function abnormalities include a decrease in gas transfer factor [28±30], an elevated functional residual capacity (FRC) and raised residual volume (RV) during periods of active bowel disease [30±32] and an increased frequency of bronchial hyperresponsiveness [33]. Further-more, alveolar lymphocytosis is evident in bronchoalveolar lavage fluid from CD patients without respiratory symptoms [34].The chest radiograph is often normal in patients with respiratory symptoms and inflammatory bowel disease (IBD) [6,8] and as a result the radiological characteristics remain poorly characterized. Two studies described the high resolution computed tomographic findings in seven patients (in each study) with IBD who presented with cough and sputum production. However, these reports did not correlate the computed tomographic appearances with symptoms or pulmonary physiology or evaluate air trapping with scans performe...

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“…Pulmonary complications may develop and progress independently of intestinal disease, and often occur years after colectomy, as observed in our patient 5 6 9 12 13 17 19. This may be related to the withdrawal of immunosuppressive medications following definitive UC therapy with colectomy, or by the shifting of inflammatory epitopes and targets to the pulmonary epithelium following colectomy 1 2 5 6 12 15 16…”

Section: Discussionmentioning

confidence: 59%

“…UC-related airway disease can occur anywhere in the tracheobronchial tree, with bronchiectasis, chronic bronchitis and chronic bronchiolitis accounting for nearly half of UC-related pulmonary disease after medication-related pulmonary toxicity is excluded (table 1). 2–5 16 17 UC-related pulmonary complications appear to have a female predominance and onset occurs in the fifth decade of life, or, as in this case, after colectomy 2 15 18…”

Section: Discussionmentioning

confidence: 92%