Korean J Gastroenterol.  2018 Sep;72(3):141-145. 10.4166/kjg.2018.72.3.141.

Pulmonary Extraintestinal Manifestation of Crohn's Disease Treated Successfully with Adalimumab

• Shin D
• Park BK
• Seo J
• Won SY
• Lee MK
• Hong YK
• Cho YS

• KMID: 2420752
• DOI: http://doi.org/10.4166/kjg.2018.72.3.141

Abstract

Pulmonary extraintestinal manifestation is rare in Crohn's disease and has been reported in only a few cases. Despite the presence of pulmonary abnormalities in a significant proportion of patients with inflammatory bowel disease, there are only few case reports, due to complicated diagnosis and low recognition by clinicians. Currently, treatment guidelines for pulmonary Crohn's disease have not been established. There are some case reports of pulmonary Crohn's disease that achieved remission after infliximab treatment. Clinical and radiological remission of pulmonary extraintestinal involvement in Crohn's disease after adalimumab therapy has not been reported yet. Here, we report one case of lung involvement of Crohn's disease, which shows radiological and clinical remission after adalimumab treatment.

Keyword

Crohn disease; Inflammatory bowel diseases; Multiple pulmonary nodules; Extraintestinal manifestation

MeSH Terms

Adalimumab*
Crohn Disease*
Diagnosis
Humans
Inflammatory Bowel Diseases
Infliximab
Lung
Multiple Pulmonary Nodules
Adalimumab
Infliximab

Figure

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  Fig. 1 Chest CT findings revealed multiple ill-defined pulmonary nodules (arrows) in bilateral lung fields. CT, computed tomography.

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  Fig. 2 Colonoscopy findings showing multiple various sized longitudinal ulcers and perianal ulcers with edematous changes.

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  Fig. 3 PET-CT showed multiple various sized ill-defined pulmonary nodules (arrows) with highly increased 18F-FDG uptake (pSUV 3.67–8.88). PET, positron emission tomography; CT, computed tomography; 18F-FDG, fluorine-18 fluorodeoxyglucose; pSUV, peak standardized uptake value.

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  Fig. 4 (A) The surgical field observed by video-assisted thoracoscopy showing whitish mucous patch-like lesion (arrow). (B) Two ill-demarcated necrotic lesions (arrows) are shown on gross photograph after thoracic wedge resection.

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  Fig. 5 (A) Prominent parenchymal geographical necrosis is observed (H&E, ×40). (B) Necrotizing granuloma (H&E, ×200). (C) Organizing pneumonia involving lung parenchyma (H&E, ×100).

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  Fig. 6 Significantly decreased previous lung nodules noted on follow-up chest CT findings. CT, computed tomography.

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