Granulomatous Bronchiolitis with Necrobiotic Pulmonary Nodules in Chrohn's Disease

A 37-year-old man with extensive Crohn's disease of the stomach, small and large intestine for almost a decade developed respiratory symptoms and radiological findings suggestive of pneumonia that failed to resolve with antibiotic treatment. Computed tomography scanning of his lungs showed extensive changes with cavitated parenchymal nodules. Histological evaluation of an open lung biopsy showed granulomatous bronchiolitis and pulmonary necrobiosis. Treatment with steroids and immunosuppression resulted in complete resolution of his clinical symptoms of pneumonia and abnormal computed tomography imaging changes. Granulomatous bronchiolitis and necrobiotic nodules may be a manifestation of Crohn's disease in the absence of microbial agents, including mycobacteria or fungal agents. While a multiplicity of complex pulmonary changes may occur in Crohn's disease, their clinical recognition and precise pathological definition may be particularly important if treatment with a biological agent, such as infliximab, is being considered.

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Computed tomography (CT) enteroclysis in comparison to lleo-colonoscopy in patients with Crohn's disease (CD)

Gastroenterology ◽

10.1016/s0016-5085(01)80015-9 ◽

2001 ◽

Vol 120 (5) ◽

pp. A3-A3

Author(s):

C HASSAN ◽

P CERRO ◽

A ZULLO ◽

C SPINA ◽

S MORINI

Keyword(s):

Computed Tomography ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Ct Enteroclysis

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Role of Probiotics and Their Metabolites in Inflammatory Bowel Diseases (IBDs)

Gastroenterology Insights ◽

10.3390/gastroent12010006 ◽

2021 ◽

Vol 12 (1) ◽

pp. 56-66

Author(s):

Toumi Ryma ◽

Arezki Samer ◽

Imene Soufli ◽

Hayet Rafa ◽

Chafia Touil-Boukoffa

Keyword(s):

Ulcerative Colitis ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Clinical Symptoms ◽

Therapeutic Potential ◽

Short Chain Fatty Acids ◽

Active Metabolites ◽

Complex Disorders ◽

Inflammatory Bowel

Inflammatory Bowel Disease (IBD) is a term used to describe a group of complex disorders of the gastrointestinal (GI) tract. IBDs include two main forms: Crohn’s Disease (CD) and Ulcerative Colitis (UC), which share similar clinical symptoms but differ in the anatomical distribution of the inflammatory lesions. The etiology of IBDs is undetermined. Several hypotheses suggest that Crohn’s Disease and Ulcerative Colitis result from an abnormal immune response against endogenous flora and luminal antigens in genetically susceptible individuals. While there is no cure for IBDs, most common treatments (medication and surgery) aim to reduce inflammation and help patients to achieve remission. There is growing evidence and focus on the prophylactic and therapeutic potential of probiotics in IBDs. Probiotics are live microorganisms that regulate the mucosal immune system, the gut microbiota and the production of active metabolites such as Short-Chain Fatty Acids (SCFAs). This review will focus on the role of intestinal dysbiosis in the immunopathogenesis of IBDs and understanding the health-promoting effects of probiotics and their metabolites.

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Musculoskeletal Complications of Crohn's Disease: The Role of Computed Tomography in Diagnosis and Patient Management

Orthopedics ◽

10.3928/0147-7447-20001101-17 ◽

2000 ◽

Vol 23 (11) ◽

pp. 1181-1185

Author(s):

Howard I Brenner ◽

Elliot K Fishman ◽

Mary L Harris ◽

Theodore M Bayless

Keyword(s):

Computed Tomography ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Patient Management

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Low-Dose Computed Tomography for the Optimization of Radiation Dose Exposure in Patients with Crohn’s Disease

Gastroenterology Research and Practice ◽

10.1155/2018/1768716 ◽

2018 ◽

Vol 2018 ◽

pp. 1-10 ◽

Cited By ~ 2

Author(s):

Richard G. Kavanagh ◽

John O’Grady ◽

Brian W. Carey ◽

Patrick D. McLaughlin ◽

Siobhan B. O’Neill ◽

...

Keyword(s):

Computed Tomography ◽

Crohn’S Disease ◽

Image Quality ◽

Crohn's Disease ◽

Radiation Dose ◽

Ionizing Radiation ◽

Low Dose ◽

Radiation Doses ◽

Radiation Dose Exposure ◽

Ct Technology

Magnetic resonance imaging (MRI) is the mainstay method for the radiological imaging of the small bowel in patients with inflammatory bowel disease without the use of ionizing radiation. There are circumstances where imaging using ionizing radiation is required, particularly in the acute setting. This usually takes the form of computed tomography (CT). There has been a significant increase in the utilization of computed tomography (CT) for patients with Crohn’s disease as patients are frequently diagnosed at a relatively young age and require repeated imaging. Between seven and eleven percent of patients with IBD are exposed to high cumulative effective radiation doses (CEDs) (>35–75 mSv), mostly patients with Crohn’s disease (Newnham E 2007, Levi Z 2009, Hou JK 2014, Estay C 2015). This is primarily due to the more widespread and repeated use of CT, which accounts for 77% of radiation dose exposure amongst patients with Crohn’s disease (Desmond et al., 2008). Reports of the projected cancer risks from the increasing CT use (Berrington et al., 2007) have led to increased patient awareness regarding the potential health risks from ionizing radiation (Coakley et al., 2011). Our responsibilities as physicians caring for these patients include education regarding radiation risk and, when an investigation that utilizes ionizing radiation is required, to keep radiation doses as low as reasonably achievable: the “ALARA” principle. Recent advances in CT technology have facilitated substantial radiation dose reductions in many clinical settings, and several studies have demonstrated significantly decreased radiation doses in Crohn’s disease patients while maintaining diagnostic image quality. However, there is a balance to be struck between reducing radiation exposure and maintaining satisfactory image quality; if radiation dose is reduced excessively, the resulting CT images can be of poor quality and may be nondiagnostic. In this paper, we summarize the available evidence related to imaging of Crohn’s disease, radiation exposure, and risk, and we report recent advances in low-dose CT technology that have particular relevance.

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Pulmonary Crohn's Disease in Down Syndrome: A Link or Linkage Problem

Case Reports in Gastroenterology ◽

10.1159/000445975 ◽

2016 ◽

Vol 10 (2) ◽

pp. 206-211

Author(s):

Danyal Thaver ◽

Mirza Beg

Keyword(s):

Down Syndrome ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Pediatric Population ◽

Pulmonary Nodules ◽

Pulmonary Involvement ◽

Lung Nodules ◽

Inflammatory Disorder ◽

Ct Guided ◽

History Of

Crohn’s disease (CD) is an autoimmune inflammatory disorder that primarily affects the gastrointestinal tract. It may have pulmonary involvement, which has been rarely reported in pediatric patients. Down syndrome (DS) has been associated with increased frequency of autoimmune diseases. However, associations between CD and DS have been rarely reported. We present the case of a 5-year-old girl with known DS and a history of chronic intermittent abdominal pain who presented with persistent pneumonia. Her workup included a chest computed tomography (CT) scan that showed multiple noncalcified pulmonary nodules. An extensive infectious workup was done that was negative. CT-guided needle biopsy of the lung nodules showed necrotizing granulomas. This raised concern for primary CD with extraintestinal pulmonary manifestation. An esophagogastroduodenoscopy and colonoscopy were performed, and colon biopsies showed scattered epithelioid granulomas. Based on this information, there was consensus that her lung nodules were secondary to CD. She was started on standard therapy for CD, and her abdominal and respiratory symptoms gradually improved. However, she continues to have mild residual lung calcification and fibrosis. To our knowledge, this is the first reported case of pulmonary CD in a child with DS. The natural history of pulmonary CD in the pediatric population is not very well studied. Furthermore, since DS has been well known to be associated with increased frequency of malignancies and autoimmune conditions due to immune dysregulation, it is difficult to predict the severity and possible complications in this patient.

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Riboflavin Supplementation in Patients with Crohn’s Disease [the RISE-UP study]

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz208 ◽

2019 ◽

Vol 14 (5) ◽

pp. 595-607 ◽

Cited By ~ 3

Author(s):

Julius Z H von Martels ◽

Arno R Bourgonje ◽

Marjolein A Y Klaassen ◽

Hassan A A Alkhalifah ◽

Mehdi Sadaghian Sadabad ◽

...

Keyword(s):

Oxidative Stress ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Disease Activity ◽

Clinical Symptoms ◽

Fish Analysis ◽

Markers Of Inflammation ◽

Anti Inflammatory ◽

Faecal Microbiome ◽

Chronic Intestinal Inflammation

Abstract Background and Aims Crohn’s disease [CD] is characterised by chronic intestinal inflammation and dysbiosis in the gut. Riboflavin [vitamin B2] has anti-inflammatory, antioxidant and microbiome-modulatory properties. Here, we analysed the effect of riboflavin on oxidative stress, markers of inflammation, clinical symptoms, and faecal microbiome in patients with CD. Methods In this prospective clinical intervention study, patients received 100 mg riboflavin [DSM, Nutritional Products Ltd] daily for 3 weeks. Clinical disease activity [Harvey-Bradshaw Index: HBI], serum biomarkers of inflammation and redox status [plasma free thiols], and faecal microbiome taxonomical composition and functionality [fluorescent in situ hybridisation: FISH; and metagenomic shotgun sequencing: MGS], were analysed before and after riboflavin intervention. Results In total, 70 patients with CD with varying disease activity were included. Riboflavin supplementation significantly decreased serum levels of inflammatory markers. In patients with low faecal calprotectin [FC] levels, IL-2 decreased, and in patients with high FC levels, C-reactive protein [CRP] was reduced and free thiols significantly increased after supplementation. Moreover, HBI was significantly decreased by riboflavin supplementation. Riboflavin supplementation led to decreased Enterobacteriaceae in patients with low FC levels as determined by FISH; however, MGS analysis showed no effects on diversity, taxonomy, or metabolic pathways of the faecal microbiome. Conclusions Three weeks of riboflavin supplementation resulted in a reduction in systemic oxidative stress, mixed anti-inflammatory effects, and a reduction in clinical symptoms [HBI]. FISH analysis showed decreased Enterobacteriaceae in patients with CD with low FC levels, though this was not observed in MGS analysis. Our data demonstrate that riboflavin supplementation has a number of anti-inflammatory and anti-oxidant effects in CD.

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