Extraintestinal manifestations of ulcerative colitis are common, occurring in up to 45 percent of patients, and include uveitis, arthritis, skin lesions, and liver disease. In contrast, pulmonary involvement in ulcerative colitis is very uncommon, having been reported in only three of 1,400 patients (0.21 percent) with inflammatory bowel disease. However, a variety of bronchopulmonary disorders has been associated with ulcerative colitis, including bronchiectasis, pleural effusions, apical fibrosis, and pulmonary vasculitis. When present, bronchopulmonary manifestations of ulcerative colitis usually follow the onset of intestinal symptoms and may actually present many years after proctocolectomy for ulcerative colitis. To expand the clinical spectrum of ulcerative colitis-associated lung disease, we describe a patient with panbronchiolitis associated with ulcerative colitis whose lung disease preceded the onset of bowel symptoms by five years. The two distinctive aspects of this case include the association between panbronchiolitis and ulcerative colitis, as well as the onset of pulmonary symptoms prior to bowel manifestations. www.cheap-asthma-inhalers.com
A 25-year-old man, a nonsmoker, was first admitted to the Cleveland Clinic Hospital in July 1987 for a total proctocolectomy, following three years of persisting abdominal cramps and bloody diarrhea refractory to therapy with high doses of prednisone and azulfidine. Previous colonoscopic biopsy had shown ulcerative colitis. An initially unexplained pulmonary disease had begun in 1979, five years prior to his initial intestinal complaints. Pulmonary symptoms consisted of congestion, dyspnea, and cough productive of copious purulent sputum. Early evaluation of his pulmonary symptoms included a nondiagnostic bronchoscopy, and initial empiric therapy with prednisone controlled his symptoms completely, although reduction in the prednisone dose below 10 mg/day resulted in a relapse of cough, phlegm, and dyspnea. He was referred to the Mayo Clinic in August 1982 for initial pulmonary evaluation, when physical examination results revealed diffuse wheezing and rales.