Freeman Hugh J, Davis Jennifer E, Prest Marcia E, Lawson Edward J
Department of Medicine, University of British Columbia Hospital, Vancouver, Canada.
Can J Gastroenterol. 2004 Nov;18(11):687-90. doi: 10.1155/2004/729689.
A 37-year-old man with extensive Crohn's disease of the stomach, small and large intestine for almost a decade developed respiratory symptoms and radiological findings suggestive of pneumonia that failed to resolve with antibiotic treatment. Computed tomography scanning of his lungs showed extensive changes with cavitated parenchymal nodules. Histological evaluation of an open lung biopsy showed granulomatous bronchiolitis and pulmonary necrobiosis. Treatment with steroids and immunosuppression resulted in complete resolution of his clinical symptoms of pneumonia and abnormal computed tomography imaging changes. Granulomatous bronchiolitis and necrobiotic nodules may be a manifestation of Crohn's disease in the absence of microbial agents, including mycobacteria or fungal agents. While a multiplicity of complex pulmonary changes may occur in Crohn's disease, their clinical recognition and precise pathological definition may be particularly important if treatment with a biological agent, such as infliximab, is being considered.
一名37岁男性，患有广泛性胃、小肠和大肠克罗恩病近十年，出现呼吸道症状及影像学表现提示肺炎，抗生素治疗无效。其肺部计算机断层扫描显示广泛改变，伴有空洞性实质结节。开胸肺活检的组织学评估显示肉芽肿性细支气管炎和肺坏死。使用类固醇和免疫抑制治疗后，其肺炎临床症状及计算机断层扫描异常影像改变完全消退。肉芽肿性细支气管炎和坏死性结节可能是克罗恩病在无微生物病原体（包括分枝杆菌或真菌病原体）情况下的一种表现。虽然克罗恩病可能出现多种复杂的肺部改变，但如果考虑使用生物制剂（如英夫利昔单抗）进行治疗，对其临床识别及精确的病理定义可能尤为重要。
