P111. Pulmonary involvement in Crohn's disease patients
M. Di Girolamo1, A. Scarcelli1, A. Bertani1, A. Sartini1, A. Merighi1, C. Ruggiero1, U. Morandi1, E. Villa1, 1Policlinico Modena, Italy
Crohn's Disease (CD) is associated with extraintestinal manifestations. Pulmonary lesions (PLs) are still poorly characterized, even if there are growing number of reports about drug-induced PLs (ASA) and incidentalomas (screening Rx/CT scan) in symptomatic and asymptomatic patients, respectively. PLs are clinically chronic bronchitis and bronchiolitis, and histologically nonnectrotizing granulomatous inflammation. Biopsy or a surgical intervention and microbiological tests are needed to make differential diagnosis. Therapy consists generally in surgical removal, but some cases of marked improvement during anti-TNFa therapy exist.
We report our experience of 2 asymptomatic pts with pulmonary nodules. A 47 year-old woman with ileal CD, affected by thalassemic trait, systemic sclerosis, Raynaud, in therapy with ASA and prostaglandins, p-ANCA positive; due to lymphadenopathy ultrasound evidence, she performed a CT scan, which showed a consolidative parenchymal area in the middle lobe, with circumscribed consolidation focal area in the lingula and nodulariform thickening in the right lower lobe. PET-CT scan showed glucose hypermetabolism. She underwent to surgery, with the diagnosis of outbreaks of chronic nonnecrotizing giant cell granulomatous inflammation, pleural and septal organized fibrosis, coexisting aspects of organizing pneumonia, chronic pleurisy with follicular bronchiolitis; no evidence of malignancy. Typical and atypical mycobacterial infection tests were negative. A 69 year-old man with ileum-colic CD and evidence of a lower right pulmonary lobe incidentaloma during a screening Rx, confirmed by PET-CT scan, without altered glucose metabolism. He therefore underwent an atypical lower right pulmonary lobe resection, with diagnosis of outbreaks of chronic giant cell granulomatous peri-bronchiolar inflammation with some vascultic aspetcs and concomitant organized pneumonia. Typical and atypical mycobacterial infections tests were negative.
Excluding infectious and malignancy, in our opinion they could be pulmonary involvement of CD, expression of its autoimmune aetiology.
Pulmonary involvement is not a rare extraintestinal manifestation of CD. The majority of PLs reported were diffuse interstitial pneumonitis, with non-caseating granulomas. It is necessary to make a diagnosis, excluding infectious and malignancy, and treat with appropriated surgical therapy.