Nunes Isabel Serra, Abreu Marlene, Corujeira Susana, Oliveira Juliana, Tavares Marta, Rocha Cristina, Lopes Joanne, Carneiro Fátima, Dias Jorge Amil, Trindade Eunice
Pediatric Gastroenterology Unit, Centro Hospitalar São João, Porto, Portugal.
Pathology Department, Centro Hospitalar de São João, Porto, Portugal.
GE Port J Gastroenterol. 2016 Jun 21;23(5):259-263. doi: 10.1016/j.jpge.2016.03.002. eCollection 2016 Sep-Oct.
Inflammatory bowel disease may cause both intestinal and extraintestinal manifestations. Respiratory symptoms in ulcerative colitis are rare and tracheal involvement is exceedingly rare in children.
CASE 1: Sixteen year-old female with a 4-week-complaint of abdominal pain, bloody diarrhea, fever and cough. The investigation was consistent with the diagnosis of concomitant ulcerative colitis/coinfection to . On day 4 respiratory signs persisted so azithromycin and inhaled corticosteroids were added. By day 6 she progressed to respiratory failure and was diagnosed with necrotic tracheitis so started on intravenous steroids with fast clinical improvement.
CASE 2: Twelve-year-old male adolescent with ulcerative colitis and sclerosing cholangitis started dry cough and throat pain 10 days after diagnosis. Laboratory investigations showed increased inflammatory signs and normal chest X-ray. He started treatment with azithromycin without clinical improvement and on day five he presented dyspnea and fever. Laryngeal fibroscopy suggested tracheitis and so systemic steroids where added with fast clinical and analytic improvement.
Tracheitis should be suspected if there are persistent respiratory symptoms even when exams are normal. Early recognition and early treatment are essential for a good prognosis preventing progression to respiratory failure.
炎症性肠病可导致肠道和肠外表现。溃疡性结肠炎的呼吸道症状罕见，儿童气管受累极为罕见。
病例1：一名16岁女性，有4周的腹痛、血性腹泻、发热和咳嗽主诉。检查结果符合溃疡性结肠炎合并感染的诊断。第4天呼吸道症状持续存在，因此加用阿奇霉素和吸入性糖皮质激素。到第6天，她进展为呼吸衰竭，被诊断为坏死性气管支气管炎，因此开始静脉使用类固醇，临床症状迅速改善。
病例2：一名12岁男性青少年，患有溃疡性结肠炎和硬化性胆管炎，诊断后10天开始出现干咳和咽痛。实验室检查显示炎症指标升高，胸部X线正常。他开始使用阿奇霉素治疗，但临床症状无改善，第5天出现呼吸困难和发热。喉镜检查提示气管支气管炎，因此加用全身类固醇，临床和分析结果迅速改善。
即使检查正常，但如果存在持续的呼吸道症状，应怀疑气管支气管炎。早期识别和早期治疗对于预防进展为呼吸衰竭、获得良好预后至关重要。
