Bronchopulmonary manifestation in Crohn's disease

Symptomatic bronchopulmonary involvement is a rare extraintestinal complication of Crohn's disease. 18 months after the diagnosis of chronic inflammatory bowel disease a 16-year old female patient developed prolonged afebrile laryngotracheobronchitis and weight loss. Sulfasalazine treatment had been continued up to this stage and there were no concomitant intestinal symptoms. Pulmonary function testing revealed mild restrictive impairment,the chest x-ray showed bilaterally increased interstitial marking. On bronchoscopy there was subglottic laryngitis and granulomatous non-purulent bronchitis. In bronchial biopsies submucous non-caseating granulomas with epitheloid cells could be demonstrated histologically. While clinical symptoms regressed spontaneously over the next weeks, pulmonary function impairment persisted over many months. Discussion: Respiratory involvement in Crohn's disease can occur during remission of abdominal symptoms. The differential diagnosis of respiratory symptoms in patients with Crohn's disease should always include extraintestinal manifestations of the primary disease.