Abstract
Introduction: Various interstitial lung diseases (ILD) have been reported in inflammatory bowel diseases (IBD) but most publications are limited to small series or predate the 2002 ATS/ERS statement on idiopathic interstitial pneumonias.
Aims: To describe the epidemiological, clinical, radiological and pathological characteristics of IBD-associated ILD.
Methods: This is a monocentric retrospective study of 9 patients with IBD-associated ILD refered from 1990 to 2010. Patients were classified according to HRCT and pathological patterns of ILD as recommended by 2002 ATS/ERS statement.
Results: There were 5 men and 4 women with a mean age of 49±7 years (Crohn's disease: n=4, ulcerative colitis: n=3, undetermined colitis: n=2). ILD developped in the course of previously known IBD in 7 cases, with a median delay of 10 years, while IBD was diagnosed after ILD in 2 cases. Surgical lung biopsy was available in 4 patients. ILD final diagnoses were: “hypersensitivity pneumonitis” (“HSP”): n=4, nonspecific interstitial pneumonia (NSIP): n=2, NSIP secondary to “HSP”: n=1, combined pulmonary fibrosis and emphysema: n=1, bronchiolitis: n=1. No patient had overt environnemental exposure but 4 patients received mesalazine at the onset of ILD, of which only one with “HSP”. One patient with NSIP also had dermatomyositis. Baseline FVC was 65±19% and DLCO 34±8%. ILD worsened despite corticosteroids in 7 patients who required other immunosuppressive drugs. At the end of follow-up (4.3±2.6 years), 2 patients died and 1 was transplanted.
Conclusion: Our study outlines the severity of IBD-associated ILD and the high frequency of “HSP”, raising the possible role of a particular unrecognised antigen in such a context.
- © 2011 ERS
