Abstract Introduction Inflammatory bowel disease (IBD) is a chronic, immune-mediated condition affecting the gastrointestinal (GI) tract. The two major forms are Ulcerative colitis (UC) and Crohn’s disease (CD), which differ in distribution, extent and pattern of inflammation. Although primarily gastrointestinal, IBD is associated with extraintestinal manifestations, including arthritis, erythema nodosum, pyoderma gangrenosum, and primary sclerosing cholangitis. Pulmonary involvement has been historically underrecognized but includes tracheobronchial, parenchymal, and pleural disease. Bronchiectasis is the most frequently reported respiratory manifestation, occurring in up to 66% of affected patients. We present a case of severe bronchiectasis in an elderly male following several years after colectomy for UC. Case Presentation An 81-year-old male with UC status post-colectomy (1987) presented with worsening productive cough and dyspnea for several months. He denied fever, weight loss, tobacco use, or environmental exposures.Examination revealed decreased breath sounds with right-sided wheezing, normal cardiac findings, no clubbing, and trace edema. Laboratory data showed mild leukocytosis and peripheral eosinophilia. Immunoglobulin levels were normal. Autoimmune and infectious workup—including ANA, Anti-Ro/La, anti-CCP, ANCA, tuberculosis testing, α-1 antitrypsin, and sweat chloride tests were negative. Anti Saccharomyces cerevisiae antibodies (ASCA) were markedly elevated (IgA 116.9, IgG 45.5). CT imaging showed right-sided bronchiectasis, airway wall thickening, and narrowing of the right main bronchus. He had bronchoscopy and balloon dilatation performed for right mainstem stenosis. Endobronchial biopsies revealed acute and chronic inflammation with squamous metaplasia-findings commonly seen in IBD related airway involvement. He was treated with systemic corticosteroids and adalimumab and reported significant improvement in his symptoms of cough and dyspnea. Conclusion Pulmonary involvement is an important but underrecognized extraintestinal manifestation of IBD. Chronic or unexplained bronchiectasis in IBD patients should prompt evaluation for immune-mediated airway disease. Detailed history, assessment for airway disease with pulmonary function testing and chest imaging studies are essential for diagnosis. Management is challenging as there are no guideline based therapies for IBD lung disease in absence of GI symptoms and with history of total colectomy. Early recognition and intervention can prevent irreversible airway damage and improve quality of life. We report a successful treatment with use of anti TNF alpha therapy. This case underscores the importance of multidisciplinary care and heightened clinical suspicion for IBD-associated pulmonary disease. This abstract is funded by: None
Hasan et al. (Fri,) studied this question.