B63-11 Unmasking Pulmonary Crohn’s Disease: A Rare Cause of Respiratory Failure in a Pediatric Patient

Introduction Crohn’s disease (CD) in children often causes extensive intestinal damage and rapid progression, affecting over 50,000 children in the U.S. While extra-intestinal manifestations like oral ulcers and arthritis are common, pulmonary involvement is rare and underreported. This case report details a 14-year-old female with CD who, after admission for suspected bacteremia, developed respiratory failure requiring mechanical ventilation, highlighting the need for increased awareness of pulmonary complications in pediatric CD. Case Presentation A 14-year-old female with a history of Crohn’s disease, diagnosed at age 8, was admitted for fever and anemia of chronic disease. By day 2 of admission, she required increasing oxygen support due to desaturation, initially thought to be secondary to infection vs limited mobility. Despite appropriate antibiotics for a central line-associated MSSA infection, she remained persistently febrile. Given her history of rectovaginal fistulas, CT abdomen and pelvis was obtained which revealed multiple lung nodules on bilateral bases of the lungs. A follow-up CT of the chest identified pulmonary emboli and bilateral numerous pulmonary nodules. Follow up CT-guided biopsy with histopathological analysis of the right lower lobe nodule confirmed the nodules as an extra-intestinal manifestation of Crohn’s disease (Figure 1). Post biopsy, patient developed respiratory decompensation requiring to be intubated for 4 days. She was gradually weaned off to RA and initiated on appropriate biologic therapy prior to discharge. Discussion This case highlights the rare pulmonary involvement in pediatric Crohn’s disease, an area often underreported in the literature. Pulmonary complications occur in 1-10% of Crohn’s patients, but pediatric cases are less recognized. The patient’s persistent oxygen dependence, despite minimal GI symptoms, underscores the need for increased awareness of pulmonary involvement in Crohn’s. Immunosuppressive therapies, including steroids, immunomodulators, and biologics, helped control symptoms and limit disease progression. This case highlights the need for early detection of pulmonary symptoms in pediatric Crohn’s and underscores the need for further research. Conclusion Pulmonary manifestations of Crohn’s disease in the pediatric population remain underrecognized, leading to diagnostic and treatment delays. Symptoms can vary from mild respiratory issues to severe pulmonary dysfunction, often not linked to Crohn’s disease. Early suspicion and clinical vigilance are critical for managing refractory respiratory problems during hospitalization of this patient population. This abstract is funded by: None