Granulomatous Tracheo-Bronchitis Associated With Crohn's Disease

Authors: Kai Xia, MD, PhD; Jacqueline Wolf, MD; Sonia Friedman, MD; David L. Carr-Locke, MD, FRCPSeries Editor: David L. Carr-Locke, MD, FRCP

Disclosures

February 20, 2004

Abstract and Introduction

We report a rare case of diffuse tracheo-bronchitis as a complication of Crohn's disease. A young man with a long-standing history of Crohn's enterocolitis initially presented with epigastric pain and melena. Upper endoscopy revealed erythematous, edematous, and friable mucosa with erosions, particularly in the pyloric channel, causing gastric outlet obstruction, and a nonbleeding ulcer in the corpus of stomach. Biopsy of these lesions showed chronic gastritis and a noncaseating epithelioid granuloma, consistent with active Crohn's disease. The patient was treated with a course of corticosteroids and the gastric symptoms resolved. A few months later, he developed fever, cough, hemoptysis, and rash. Bronchoscopy demonstrated a markedly thickened and very inflamed trachea with extensive friable, whitish lesions and ulcerations. Histology showed severe noncaseating granulomatous inflammation. The patient improved with a 6-week oral, followed by an additional 4-week inhaled, corticosteroid treatment. Since then, he has been doing well without relapse of pulmonary symptoms for 2 years.

Crohn's disease has long been recognized to cause both intestinal and extraintestinal complications. The intestinal complications related to inflammatory activity include obstruction, severe hemorrhage, acute perforation, fistula, abscess formation, and toxic megacolon. The extraintestinal complications are generally divided into 2 groups: (1) manifestations that occur concurrently with intestinal disease activity, such as uveitis, episcleritis, erythema nodosum, and peripheral inflammatory arthritis; or (2) diseases that occur independently of intestinal disease activity, such as ankylosing spondylitis, sacroileitis, or primary sclerosing cholangitis. Pyoderma gangrenosum may occur in both groups. There is accumulating evidence that Crohn's disease can also be associated with a variety of respiratory disorders.[1] Anecdotal accounts of bronchopulmonary involvement have been reported in patients with Crohn's disease, including unexplained chronic bronchitis,[2] bronchiolitis obliterans organizing pneumonia,[2] and granulomatous and nongranulomatous interstitial lung disease.[3,4] In this report, we describe a patient who developed granulomatous tracheo-bronchitis as a complication of long-standing Crohn's disease.

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