SAGES Magazine

THE SOUTH AFRICAN GASTROENTEROLOGY REVIEW 2022 | VOLUME 20 | ISSUE 1 | 29 CASE REPORT Extra-intestinal manifestations (EIMs) occur in 6% to 47% of patients with inflammatory bowel disease (IBD), depending on the definition used. ¹ Pulmonary EIMs are considered rare; however, they are increasingly recognised. Here we report the case of a young female patient with newly diagnosed severe ulcerative colitis and advanced pulmonary fibrosis. A 39-year-old female was referred to our hospital with a 2-month history of bloody diarrhoea, abdominal cramps and marked weight loss. She had associated loss of appetite but no vomiting, fevers or night sweats. The main differentials were infectious colitis (commonly amoebic colitis or intestinal tuberculosis) and idiopathic IBD. A colonic malignancy was considered less likely. Apart from bilateral tubal ligation she had no reported prior medical history and was HIV negative. She was a housewife with 3 children. A chest x-ray done at the referring hospital (shown below) had shown extensive bilateral reticular changes suggestive of a chronic or acute-on chronic process. The patient denied cough or night sweats but admitted to mild chronic dyspnoea on exertion of insidious onset with minimal limitation of ordinary physical activity. The duration of respiratory symptoms could not be ascertained but was likely many months. There was no history of arthralgias, changes in vision, or skin rashes. She was a lifelong non-smoker, with no secondary smoke and took no alcohol. There was no history of prior TB or TB contacts and no history of (recurrent) respiratory infections. On examination she was wasted with a weight of 40kg and a BMI of 17. General examination revealed pallor, bilateral pitting ankle oedema and digital finger clubbing, but no lymphadenopathy, cyanosis or muco-cutaneous lesions. Vital signs were blood pressure 93/63mmHg, pulse 112/minute, respiratory rate 20/minute, temperature 36.1 °C and finger-prick glucose of 3.8mmol/l. Abdominal examination revealed a 5cm non- tender right iliac fossa mass (later shown to be an ovarian cyst) and mild left iliac fossa tenderness without peritonitis. Bowel sounds were normal and there were no perianal lesions or fistulae. The chest examination revealed minimal hyperinflation with bilateral dullness and reduced breath sounds in the posterior lung bases. There were minimal basal end- inspiratory crackles and a pleural rub was present. There were no features of pulmonary hypertension or heart failure on cardiac examination. The patient had plain X-rays and computerized tomography scans of the abdomen and chest as shown below. Figure 1 Abdominal X-ray Thickened descending colon wall, lack of haustration in the transverse colon and prominent/ dilated small bowel loops TR Machiridza, Prof G Watermeyer 1 , Prof M Setshedi 1 Division of Gastroenterology, Department of Medicine, Groote Schuur Academic Hospital, University of Cape Town ,Cape Town, South Africa Key words: Inflammatory bowel disease, extra-intestinal manifestation, pulmonary Advanced pulmonary fibrosis as an extra-intestinal manifestation of inflammatory bowel disease. Correspondence Tendai R. Machiridza email: tr.machiridza@gmail.com