Talwar Ambika, Kunst Heinke, Ngatchu Theodore, Trotter Simon
Department of Respiratory Medicine, Birmingham Heartlands Hospital, Birmingham, UK.
BMJ Case Rep. 2013 Jan 2;2013:bcr0220125806. doi: 10.1136/bcr-02-2012-5806.
We present the case of a 25-year-old Afro-Caribbean man with a longstanding history of ulcerative colitis and primary sclerosing cholangitis. The patient presented to clinic and reported pleuritic-type chest pain. A routine chest radiograph requested from the clinic revealed an incidental right middle zone opacity in the right lung. A subsequent high-resolution CT showed multiple lung nodules. The patient also had a positive cytoplamic anti-neutrophil cytoplasmic antibody (cANCA) and proteinase 3 antibodies. Bronchoscopy was inconclusive. A video-assisted thoracoscopic surgery biopsy was then taken. The histology revealed changes suggestive of bronchiolitis obliterans organising pneumonia. The pulmonary manifestations of inflammatory bowel disease are poorly characterised. Our literature search has revealed cases hypothesising that immune system dysregulation could display pulmonary complications of ulcerative colitis. The aetiology is thought to be related to the treatment with mesalazine. However, our patient also had a positive vasculitic screen. Previous cases have resolved with supportive management or steroid therapy.
我们报告了一名25岁的非洲加勒比裔男性病例，该患者有溃疡性结肠炎和原发性硬化性胆管炎的长期病史。患者到诊所就诊，报告有胸膜炎样胸痛。诊所要求进行的常规胸部X线检查显示右肺中叶意外出现模糊影。随后的高分辨率CT显示多个肺结节。患者的胞浆抗中性粒细胞胞浆抗体（cANCA）和蛋白酶3抗体也呈阳性。支气管镜检查结果不明确。然后进行了电视辅助胸腔镜手术活检。组织学检查显示有提示闭塞性细支气管炎并机化性肺炎的改变。炎症性肠病的肺部表现特征尚不明确。我们的文献检索发现了一些病例，推测免疫系统失调可能会出现溃疡性结肠炎的肺部并发症。病因被认为与美沙拉嗪治疗有关。然而，我们的患者血管炎筛查也呈阳性。之前的病例通过支持治疗或类固醇治疗已得到缓解。
