Tracheobronchitis With Dense Plasma Cell Infiltration Several Years Postcolectomy for Ulcerative Colitis

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Pulmonary disorders are reported as rare extraintestinal manifestations of inflammatory bowel diseases. However, according to current literature, they are clinically underrecognized and likely underdiagnosed. While both parenchymal and airway lesions have been described, inflammatory bowel disease seems to preferentially affect the tracheobronchial tree, where it induces bronchiectasis, tracheobronchitis, and bronchitis. Respiratory involvement typically appears during a long-lasting disease, although symptoms of airway involvement may appear following surgery. Pathology features of tracheobronchitis have been documented in a few case reports, with histology findings varying from fibrosis without significant inflammation to dense infiltrate of acute and chronic inflammatory cells. Here, we describe a case of a 47-year-old man who developed productive cough that persisted several years after total colectomy for ulcerative colitis. Clinical workup demonstrated proximal airway inflammation associated with bronchiectasis and diffuse peribronchial thickening with significant narrowing of the middle lobe bronchi causing a complete atelectasis of the lobe. Bronchial biopsies showed a few ulcers with granulation tissue associated with significant inflammatory cell infiltration of the submucosa mainly composed of mature plasma cells and lymphocytes. Infections, vasculitis, plasmacytoma, sarcoidosis, amyloidosis, and drug-induced lung pathologies were excluded by a thorough clinical workup. The patient received a diagnosis of extraintestinal manifestations of ulcerative colitis, and treatment with systemic corticosteroids resulted in rapid clinical improvement.

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