CHEST Guidelines-A-55-Year-Old-Man-With-Cough-and-Hematochezia

A-55-Year-Old-Man-With-Cough-and-Hematochezia_ches

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The case report discusses a 55-year-old man who presented with symptoms including a worsening cough, shortness of breath, blood-tinged sputum, fever, night sweats, and weight loss. Despite treatment with antibiotics for assumed sinusitis, his symptoms persisted. His medical background included ulcerative colitis, and he experienced bloody diarrhea weeks prior. Upon examination, he had fever, tachycardia, wheezing in the left lung, conjunctivitis, ulceration in the oral cavity, and a purulent wound on his arm. Laboratory tests showed elevated white blood cell count and procalcitonin, while imaging identified a left lung infiltrate.<br /><br />The patient’s condition escalated after admission, requiring intubation due to severe respiratory failure and atrial fibrillation. Emergent bronchoscopy showed necrotic debris obstructing the left bronchus, causing necrotizing tracheobronchitis, necessitating cryoextraction to improve airflow. This intervention helped restore his breathing and normalize his heart rhythm.<br /><br />The diagnosis revealed this to be an extra-intestinal manifestation of ulcerative colitis, specifically encompassing uveitis, pyoderma gangrenosum, and necrotizing tracheobronchitis. This rare pulmonary complication, occurring in about 0.21% of IBD cases, was exacerbated by an acute colitis flare. Although the pathogenesis of lung involvement in IBD is uncertain, it is postulated to involve systemic inflammation affecting both colonic and respiratory tissues due to common embryological origins.<br /><br />The patient was treated with steroids and infliximab, showing significant clinical improvement and recovery. Within three months, his respiratory function stabilized. The report emphasizes the rarity and potential severity of pulmonary involvement in IBD and highlights the necessity for prompt treatment to prevent lasting damage.

Keywords

ulcerative colitis

pulmonary complication

necrotizing tracheobronchitis

uveitis

pyoderma gangrenosum

inflammatory bowel disease

systemic inflammation

steroids

infliximab

respiratory failure