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Bronchorrhoea complicating inflammatory bowel disease

¹ Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
² Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
³ Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA

Correspondence to:
Correspondence to:
Dr C Girod
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Texas Southwestern Medical School, Dallas, TX 75390-9034, USA; carlos.girod@utsouthwestern.edu

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A 25 year old Hispanic man with a 3 year history of ulcerative colitis presented with 8 months of productive cough with over 200 ml of yellow sputum, fatigue, dyspnoea, diarrhoea, night sweats, and weight loss. At the time of presentation the patient was on a low dose of mesalamine (400 mg three times daily) and azathioprine (25 mg/day). Examination revealed coarse crackles at the lung bases and a prolonged expiratory phase. The white blood cell count was normal. The chest radiograph showed bilateral reticulonodular infiltrates with acinonodular opacities, and a high resolution CT scan showed diffuse bronchiectasis, centrilobular nodules, and a "tree-in-bud" pattern (fig 1). Obstruction with air trapping was found on pulmonary function tests. Bronchoscopic examination showed diffuse purulent secretions throughout the major airways (fig 2A). BAL fluid smears and cultures were negative for acid-fast bacilli, fungus, and bacterial pathogens. Transbronchial biopsies revealed dense lymphoplasmacytic inflammation . . . [Full text of this article]