Letter to the Editor
Migratory Pulmonary Nodules in a Patient With Ulcerative Colitis
Nódulos pulmonares migratorios en paciente con colitis ulcerosa
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Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servei de Radiologia, Departament de Medicina, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Nódulos pulmonares migratorios en paciente con colitis ulcerosa" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 429 "Ancho" => 1590 "Tamanyo" => 116649 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Pulmonary mass in the peripheral right upper lobe (RUL) of necrotic and abscessed appearance, containing a small air bubble (mediastinal window CT image). (B) Previously described nodule has disappeared, and a new cavitated nodule has appeared close by. Bronchial wall thickening and RUL bronchial impaction (lung window CT image). (C) Resolution of previous findings (follow-up lung window CT image).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Ulcerative colitis (UC) is an intestinal inflammatory disease occasionally associated with extraintestinal complications. We report here an atypical case of pulmonary manifestations of UC.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 70-year-old man with a history of UC, stable in the last 5 years, receiving azathioprine, presented with a clinical picture of hemoptysis. Chest computed tomography (CT) was performed, revealing an 18-mm cavitated nodule in the right lower lobe. One month later, PET–CT was performed, showing nodule growth (19.5<span class="elsevierStyleHsp" style=""></span>mm) and hypermetabolism (SUV 5.77). Bronchoscopy was normal and lung function testing found mild, non-obstructive changes (FEV1/FVC 77, FEV1 [L] 2.22 [68%], FVC [l] 2.89 [65%]). Microbiology testing of endoscopy specimens, including auramine staining and <span class="elsevierStyleItalic">Mycobacterium tuberculosis</span> complex DNA detection, were negative. Four weeks later, the patient had another episode of hemoptysis and respiratory failure (pO<span class="elsevierStyleInf">2</span> 52<span class="elsevierStyleHsp" style=""></span>mmHg). Repeat chest CT showed a 7-cm mass in the right upper lobe (RUL) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). Pulmonary thromboembolism was ruled out by the contrast study. Bronchoscopy was repeated, and was normal again, and cytology and microbiology results remained negative (direct detection and bacterial, fungal and mycobacterial cultures). Pulmonary abscess was suspected, so treatment began with clindamycin with good clinical response. However, the 3-month follow-up chest CT showed that while the 7-mm RUL lesion had resolved, a new cavitated nodule had appeared in the RUL (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). To rule out the association with the patient's gastrointestinal disease, colonoscopy was performed, showing mild UC. The immunological examination (including antinuclear and anti-neutrophil cytoplasmic antibodies) was negative.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">In an attempt to determine diagnosis, pulmonary biopsy by thoracotomy was performed. Pathology laboratory reports showed sterile aggregates of neutrophils with areas of necrosis and foci of organizing pneumonia, with no evidence of vascular infiltration. These findings were thought to be indicative of UC lung involvement. Treatment began with prednisone 30<span class="elsevierStyleHsp" style=""></span>mg every 12<span class="elsevierStyleHsp" style=""></span>h for 2 weeks, with complete resolution of radiological signs (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C).</p><p id="par0020" class="elsevierStylePara elsevierViewall">UC is an inflammatory disease that affects the mucosa of the colon. It manifests mainly as diarrhea, abdominal pain and rectal bleeding.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> However, in 10%–30% of cases, it can be associated with extraintestinal manifestations, particularly in the joints, skin and eyes. Pulmonary manifestations of UC are rare, multiple and non-specific.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2,3</span></a> The most common symptoms are cough and wheezing.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Our patient presented hemoptysis and respiratory failure, unusual in the published cases.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2–4</span></a> Radiological findings also vary widely. The most common include bronchiectasis and ground-glass opacities.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> In our case, migratory cavitated pulmonary nodules were detected on CT, described elsewhere as very unusual.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> The most common histopathological changes are airway inflammation and bronchiectasis.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> Our patient's lung biopsy revealed foci of organizing pneumonia and necrobiotic nodules. These necrotic areas, seen on CT as abscesses, appeared sporadically during our patient's clinical course. To date, flare-ups of organizing pneumonia associated with UC have been described,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> but necrobiotic nodules are rarer.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> Treatment of UC lung involvement is based on corticosteroids.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> Our patient's response to corticosteroids was excellent, with complete clinical and radiological resolution after 2 weeks of treatment.</p><p id="par0025" class="elsevierStylePara elsevierViewall">To conclude, this is a case of pulmonary involvement of UC, with an interesting presentation, due to exacerbations occurring with hemoptysis, respiratory failure and radiological images of migratory cavitated pulmonary nodules, with no associated clinical symptoms. Definitive diagnosis was based on lung biopsy results and response to steroid treatment was complete.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of Interests</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors state that they have no direct or indirect conflict of interests with the contents of this manuscript.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of Interests" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Barril S, Rodrigo-Troyano A, Giménez A, Sibila O. Nódulos pulmonares migratorios en paciente con colitis ulcerosa. Arch Bronconeumol. 2015;51:303-304.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 429 "Ancho" => 1590 "Tamanyo" => 116649 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Pulmonary mass in the peripheral right upper lobe (RUL) of necrotic and abscessed appearance, containing a small air bubble (mediastinal window CT image). (B) Previously described nodule has disappeared, and a new cavitated nodule has appeared close by. Bronchial wall thickening and RUL bronchial impaction (lung window CT image). (C) Resolution of previous findings (follow-up lung window CT image).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ulcerative colitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S. Danese" 1 => "C. 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Murin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.06-1074" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2007" "volumen" => "131" "paginaInicial" => "524" "paginaFinal" => "532" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17296657" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pulmonary manifestations of inflammatory bowel disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "I. Storch" 1 => "D. Sachar" 2 => "S. Katz" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Inflamm Bowel Dis" "fecha" => "2003" "volumen" => "9" "paginaInicial" => "104" "paginaFinal" => "115" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12769444" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pulmonary nodules as respiratory manifestation of inflammatory bowel disease: case report and review" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Carrascosa" 1 => "J. Salcines-Caviedes" 2 => "M.V. Millán" 3 => "M.C. Martín" 4 => "M.Z. Murguiondo" 5 => "P.G. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 2 | 1 | 3 |
| 2024 October | 57 | 18 | 75 |
| 2024 September | 57 | 14 | 71 |
| 2024 August | 68 | 34 | 102 |
| 2024 July | 59 | 26 | 85 |
| 2024 June | 69 | 28 | 97 |
| 2024 May | 89 | 43 | 132 |
| 2024 April | 59 | 20 | 79 |
| 2024 March | 50 | 21 | 71 |
| 2024 February | 48 | 26 | 74 |
| 2023 March | 9 | 6 | 15 |
| 2023 February | 48 | 23 | 71 |
| 2023 January | 89 | 26 | 115 |
| 2022 December | 63 | 35 | 98 |
| 2022 November | 78 | 32 | 110 |
| 2022 October | 77 | 37 | 114 |
| 2022 September | 74 | 33 | 107 |
| 2022 August | 103 | 68 | 171 |
| 2022 July | 105 | 40 | 145 |
| 2022 June | 58 | 37 | 95 |
| 2022 May | 122 | 53 | 175 |
| 2022 April | 99 | 24 | 123 |
| 2022 March | 112 | 55 | 167 |
| 2022 February | 93 | 36 | 129 |
| 2022 January | 89 | 33 | 122 |
| 2021 December | 69 | 41 | 110 |
| 2021 November | 88 | 43 | 131 |
| 2021 October | 117 | 44 | 161 |
| 2021 September | 68 | 54 | 122 |
| 2021 August | 84 | 30 | 114 |
| 2021 July | 71 | 32 | 103 |
| 2021 June | 51 | 43 | 94 |
| 2021 May | 73 | 31 | 104 |
| 2021 April | 175 | 81 | 256 |
| 2021 March | 115 | 19 | 134 |
| 2021 February | 49 | 18 | 67 |
| 2021 January | 36 | 23 | 59 |
| 2020 December | 56 | 16 | 72 |
| 2020 November | 65 | 16 | 81 |
| 2020 October | 41 | 16 | 57 |
| 2020 September | 49 | 8 | 57 |
| 2020 August | 40 | 14 | 54 |
| 2020 July | 47 | 24 | 71 |
| 2020 June | 44 | 3 | 47 |
| 2020 May | 51 | 15 | 66 |
| 2020 April | 40 | 23 | 63 |
| 2020 March | 46 | 20 | 66 |
| 2020 February | 42 | 18 | 60 |
| 2020 January | 46 | 16 | 62 |
| 2019 December | 51 | 32 | 83 |
| 2019 November | 55 | 29 | 84 |
| 2019 October | 46 | 10 | 56 |
| 2019 September | 137 | 22 | 159 |
| 2019 August | 45 | 18 | 63 |
| 2019 July | 52 | 20 | 72 |
| 2019 June | 60 | 12 | 72 |
| 2019 May | 76 | 24 | 100 |
| 2019 April | 73 | 21 | 94 |
| 2019 March | 75 | 26 | 101 |
| 2019 February | 84 | 24 | 108 |
| 2019 January | 55 | 22 | 77 |
| 2018 December | 65 | 25 | 90 |
| 2018 November | 80 | 34 | 114 |
| 2018 October | 121 | 25 | 146 |
| 2018 September | 72 | 14 | 86 |
| 2018 May | 25 | 0 | 25 |
| 2018 April | 47 | 4 | 51 |
| 2018 March | 56 | 3 | 59 |
| 2018 February | 41 | 5 | 46 |
| 2018 January | 105 | 4 | 109 |
| 2017 December | 103 | 4 | 107 |
| 2017 November | 50 | 3 | 53 |
| 2017 October | 36 | 15 | 51 |
| 2017 September | 40 | 11 | 51 |
| 2017 August | 33 | 11 | 44 |
| 2017 July | 35 | 7 | 42 |
| 2017 June | 43 | 10 | 53 |
| 2017 May | 45 | 20 | 65 |
| 2017 April | 26 | 30 | 56 |
| 2017 March | 23 | 10 | 33 |
| 2017 February | 47 | 5 | 52 |
| 2017 January | 27 | 3 | 30 |
| 2016 December | 39 | 6 | 45 |
| 2016 November | 54 | 7 | 61 |
| 2016 October | 50 | 10 | 60 |
| 2016 September | 64 | 14 | 78 |
| 2016 August | 58 | 14 | 72 |
| 2016 July | 33 | 14 | 47 |
| 2016 March | 2 | 0 | 2 |
| 2015 December | 3 | 0 | 3 |
| 2015 October | 31 | 1 | 32 |
| 2015 September | 17 | 7 | 24 |
| 2015 July | 0 | 1 | 1 |
| 2015 June | 0 | 1 | 1 |
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