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Z Gastroenterol 2015; 53(09): 1091-1098
DOI: 10.1055/s-0041-103377
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Lung disease and ulcerative colitis − mesalazine-induced bronchiolitis obliterans with organizing pneumonia or pulmonary manifestation of inflammatory bowel disease?

Colitis ulcerosa und pulmonale Komplikationen – Mesalazin-induzierte Bronchiolitis obliterans oder pulmonale Manifestation einer Colitis ulcerosa
A. Moeser
1   Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
3   Clinic of Internal Medicine I, Department of Pneumology and Allergy/Immunology, Jena University Hospital, Jena, Germany
4   Clinic of Internal Medicine IV, Jena University Hospital, Jena, Germany
,
M. W. Pletz
2   Center for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
,
S. Hagel
1   Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
2   Center for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
4   Clinic of Internal Medicine IV, Jena University Hospital, Jena, Germany
,
C. Kroegel
3   Clinic of Internal Medicine I, Department of Pneumology and Allergy/Immunology, Jena University Hospital, Jena, Germany
,
A. Stallmach
4   Clinic of Internal Medicine IV, Jena University Hospital, Jena, Germany
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Publikationsverlauf

01. Februar 2015

24. März 2015

Publikationsdatum:
14. September 2015 (online)

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Abstract

Ulcerative colitis can be associated with numerous extraintestinal organ manifestations. Pulmonary disease in inflammatory bowel disease (IBD) is supposed to be a rare entity and has to be distinguished from infectious complications and side-effects of medications used in the treatment of IBD. We present the case of a 20-year-old male patient with ulcerative colitis and a 4-week history of respiratory symptoms, malaise, fever and respiratory insufficiency under a medication with mesalazine. Computed tomography showed bilateral subpleural consolidations, bronchoscopy revealed signs of acute bronchitis. The diagnostic work-up ruled out an infectious cause. Under the tentative diagnosis of a mesalazine-induced bronchiolitis obliterans with organizing pneumonia (BOOP) the medication with mesalazine was withdrawn and the patient received a corticosteroid trial. The symptoms quickly improved and prednisone was tapered and stopped after 6 months. Unexpectedly, lung function after complete resolution of respiratory symptoms revealed a residual obstructive ventilatory defect that might be due to an asymptomatic pulmonary manifestation of ulcerative colitis. A review of the literature shows that pulmonary manifestations in IBD as well as pulmonary toxicity of mesalazine might not be as rare as expected and should be included as differential diagnoses in the work-up of respiratory symptoms in patients with IBD. A pragmatic therapeutic approach is reasonable in critically ill patients as it is not always easy to distinguish both entities.

Zusammenfassung

Die chronisch-entzündliche Darmerkrankung Colitis ulcerosa (CU) kann mit zahlreichen extraintestinalen Manifestationen assoziiert sein. Insbesondere die pulmonale Beteiligung wird als eine seltene Krankheitsentität betrachtet und muss differenzialdiagnostisch von infektiösen Komplikationen und unerwünschten Nebenwirkungen der eingesetzten Medikation abgegrenzt werden. Wir berichten über den Fall eines 20-jährigen Patienten mit Colitis ulcerosa, der sich mit einer 4-wöchigen Anamnese bestehend aus Atemnot, Fieber, respiratorischer Insuffizienz, trockenem Husten und Krankheitsgefühl unter einer Medikation mit Mesalazin vorstellte. Das Computertomogramm der Lunge zeigte beidseitige subpleurale Konsolidierungen, bronchoskopisch fand sich eine akute Bronchitis. Eine infektiöse Genese der Symptome konnte in der weiterführenden Diagnostik ausgeschlossen werden. Bei einer weiteren klinischen Verschlechterung wurde unter der Verdachtsdiagnose einer Mesalazin-induzierten Bronchiolitis obliterans-organisierenden Pneumonie (BOOP) die Medikation mit Mesalazin beendet und eine systemische Steroidtherapie initiiert. Hierunter bildeten sich die Symptome rasch zurück, sodass Prednisolon innerhalb von 6 Monaten reduziert und beendet werden konnte. Überraschenderweise zeigte sich nach vollständiger klinischer und morphologischer Rückbildung der pulmonalen Veränderungen eine persistierende obstruktive Ventilationsstörung, die mit einer pulmonalen Manifestation der Colitis ulcerosa in Verbindung gebracht werden kann. Der aktuelle Literaturüberblick zeigt, dass sowohl die pulmonale Manifestation der CU als auch eine Mesalazin-assoziierte pulmonale Toxizität möglicherweise häufiger auftreten als vermutet und in die Differenzialdiagnostik pulmonaler Symptome bei Patienten mit CU einbezogen werden sollten. Insbesondere bei kritisch kranken Patienten ist ein pragmatischer therapeutischer Ansatz sinnvoll, da die Differenzierung beider Krankheitsentitäten nicht immer einfach ist.

Schlüsselwörter

chronisch entzündliche Darmerkrankung - Colitis ulcerosa - extraintestinale Manifestation

Key words

chronic inflammatory bowel disease - ulcerative colitis - extraintestinal manifestations
 

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