Pulmonary involvement in a patient with lymphocytic colitis

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Date: June 2008
From: Journal of Respiratory Diseases(Vol. 29, Issue 6)
Publisher: CMP Medica, LLC
Document Type: Case study
Length: 1,644 words
Lexile Measure: 1240L

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Microscopic colitis is a noninfectious colitis that is characterized by chronic nonbloody diarrhea and macroscopically normal colonic mucosa. Extra-intestinal manifestations are rarely seen. In this report, we describe a nonspecific interstitial pneumonitis in a patient with lymphocytic colitis.

Microscopic colitis is a distinct form of noninfectious inflammatory colitis that is characterized by chronic, watery diarrhea and a macroscopically normal colonic mucosa. Two types of microscopic colitis have been identified based on histopathological characteristics: lymphocytic colitis and collagenous colitis. Lymphocytic colitis is characterized by an increased number of intraepithelial lymphocytes. (1, 2) A diffuse and thickened subepithelial collagen layer is seen in patients with collagenous colitis.

In contrast to ulcerative colitis and Crohn disease, extraintestinal manifestations are uncommon in microscopic colitis. Pulmonary involvement is extremely rare. Wiener (3) described a case of pulmonary fibrosis diagnosed by open lung biopsy in a patient with collagenous colitis. However, the author suggested that the pulmonary involvement could be a part of systemic disease. In this case, the patient had been treated with sulfasalazine. (3) Since sulfasalazine is well known to cause pulmonary toxicity, the interstitial pneumonitis and fibrosis may have been the result of a drug reaction.

We describe a patient with lymphocytic colitis who presented with dyspnea and cough. Nonspecific interstitial pneumonitis (NSIP) was found on lung biopsy. To the best of our knowledge, this is the first reported case of NSIP in a patient with lymphocytic colitis.

The case

A 69-year-old woman presented with chronic diarrhea, dry cough, and progressive dyspnea. Nonbloody diarrhea associated with low-grade fever developed approximately 3 months before presentation. She had no abdominal pain, nausea, vomiting, heartburn, tenesmus, or jaundice. Two 255months before presentation, the patient experienced worsening cough, progressive dyspnea, and worsening diarrhea. She also reported night sweats and a 5.5-kg (12-lb) weight loss over 2 months.

The patient's medical history was significant for hypercholesterolemia, which was treated with atorvastatin for 2 years. She was a lifelong nonsmoker. Seven months before presentation, she had visited China. A detailed exposure history was unrevealing.

On presentation, physical examination revealed a temperature of 39.5[degrees]C (103.1[degrees]F), blood pressure of 122/70 mm Hg, heart rate of 89 beats per minute, and respiration rate of 17 breaths per minute. Oxygen saturation while breathing ambient air was 90%. There were no palpable lymph nodes. Chest auscultation showed bilateral scattered crackles. Findings on skin, cardiac, and abdominal examinations were unremarkable. Clubbing of the fingers and toes was absent.

Initial laboratory findings included a white blood cell...

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Gale Document Number: GALE|A180472159