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A Journal on Diseases of the Respiratory System
Official Journal of the Italian Society of Thoracic Endoscopy
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Minerva Pneumologica 2000 March;39(1):11-8
Pulmonary involvement in inflammatory bowel disease
Marvisi M., Fornasari G., Brianti M., Guariglia A.
Inflammatory bowel disease is a systemic illness that may involve the lung. The most common manifestation of pulmonary involvement is bronchial inflammation and suppuration with or without bronchiectasis, the majority of these patients have ulcerative colitis. Bronchoalveolar lavage data show an increased percentage of neutrophils and steroids are very effective in the majority of these cases. Some patients present severe tracheal inflammation and obstruction with an inflammatory mass bulging into the tracheal lumen; these subjects usually respond to methylprednisolone. Others show a small airways involvement with or without a bronchiolitis obliterans with organizing pneumonia pattern and have an equivocal response to steroids. Interstitial lung disease and pulmonary infiltrates with eosinophilia are the most difficult patterns to address because in some cases drugs such as sulfasalazine and 5-aminosalicylicacid may play a contributing role in some cases. The literature yields some cases of association of inflammatory bowel disease, in particular Crohn's disease with sarcoidosis. In recent years many investigators have demonstrated latent pulmonary involvement with a reduction in lung transfer factor and a small airways disorder. Pleuroperi-carditis is a rare manifestation commonly diagnosed in patients with acute ulcerative colitis. Tamponade has been reported in 3 patients and drainage performed in 3 others. On the other hand, subjects presenting with necrobiotic nodules have inactive intestinal disease and the histopathological pattern is distinctly reminiscent of pyoderma gangrenosum as it occurs in the skin.