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Query: UMLS:C0021390 (inflammatory bowel disease)
 23,302 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Extracolonic manifestations of inflammatory bowel disease are common and diverse. Cardiac complications, however, are rare and of these pericarditis is the most frequently described association. A 57 year old man with a 20 year history of ulcerative colitis presented with a four day history of retrosternal chest pain and exertional dyspnoea. Electrocardiogram showed Wenckebach atrioventricular block. Three days later he developed bloody diarrhoea and sigmoidoscopy showed active proctocolitis. He was treated with oral prednisolone after which the chest pain and diarrhoea settled within 48 hours. At outpatient review two weeks later he was completely well and the electrocardiogram had returned to normal.
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PMID:Ulcerative colitis complicated by Wenckebach atrioventricular block. 144 75

Rheumatoid arthritis is being increasingly treated with sulphasalazine. We report the first case of a patient being treated for rheumatoid arthritis who developed severe dyspnoea with chest radiograph shadowing, reversible on discontinuation of sulphasalazine and subsequent steroid therapy. An histological diagnosis of fibrosing alveolitis was made. Thirteen cases of similar reactions to sulphasalazine, all in patients treated for inflammatory bowel disease, can be found in the literature. We identify two types of pulmonary reaction, an eosinophilic pneumonitis and a fibrosing alveolitis. Adequate histological investigation is needed to differentiate between the two and management may be different. The diagnosis of pulmonary reactions are important because they can be easily confused with complications of the underlying disease but the prognosis is much better.
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PMID:Fibrosing alveolitis due to sulphasalazine in a patient with rheumatoid arthritis. 197 34

We report a case of toxic megacolon manifesting in cytomegalovirus (CMV) colitis in a 55-yr-old man with steroid-dependent chronic obstructive pulmonary disease. He presented to the hospital with increasing dyspnea and low-grade fever. His hospital course was characterized by the poor response of his symptoms to treatment, and by the subsequent development of intermittent hematochezia and, eventually, acute abdomen. The surgical specimen showed dilatation of the cecum and ascending colon with a solitary mucosal ulcer in the latter. The major histologic changes were limited to the area of ulceration. In addition to classical CMV inclusions. vasculitis manifested in two forms, namely, leukocytoclastic type and fibrinoid necrosis. The patient died shortly thereafter, due to multi-organ system failure. To our knowledge, this represents the first reported case of toxic megacolon due to CMV infection without underlying inflammatory bowel disease. The pathogenesis of toxic colonic dilatation remains unknown.
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PMID:Toxic megacolon in cytomegalovirus colitis. 254 94

A 66-year-old man developed chronic watery diarrhea and progressive dyspnea over 1-year. Colonic biopsy revealed a thickened subepithelial collagen layer consistent with collagenous colitis; open lung biopsy revealed pulmonary fibrosis. Only one previous report links extraintestinal manifestations to collagenous colitis. Although the patient had been taking sulfasalazine, the case supports the idea that collagenous colitis, like inflammatory bowel disease, is part of a systemic disorder.
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PMID:Collagenous colitis and pulmonary fibrosis. Manifestations of a single disease? 287 62

High temperatures, night sweat, chest pain, cough and dyspnoea suddenly occurred in a 54-year-old patient. The serious disease was accompanied by variable pulmonary infiltrations. Chemical pathology showed maximally increased sedimentation rates, slight leucocytosis and anaemia. Complete serology was negative. The occurrence of large intestinal ileus required laparatomy and after commencement of treatment with steroids the overall state improved, pulmonary symptoms disappeared, and radiographically demonstrable infiltration were clearly regressing. Histology revealed presence of acute ulcerative colitis. Lung infiltrates probably represented extraintestinal manifestation of the chronic inflammatory bowel disease. In contrast to experience from the literature lung infiltrations in this case preceded clinical manifestations of the underlying disease.
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PMID:[Bronchopulmonary infiltrates in chronic inflammatory bowel disease]. 686 56

Seven patients with severe, unexplained chronic bronchial suppuration and inflammatory bowel disease are reported. In three, rapidly progressive bronchiectasis developed within one year of procto-colectomy, in two it developed in association with an exacerbation of colitis and in the other two a milder, limited colitis post-dated the start of the lung disease. The high incidence of arthropathy and skin rashes suggests a systemic disease, and personal and family histories of auto-immune conditions were common. Antinuclear antibodies were detected in six and smooth muscle antibodies in five of the seven patients and there was no evidence of liver disease. Evidence of circulating immune complexes was found in two patients. In the four patients who received corticosteroid therapy there was an impressive improvement in cough, sputum volume and dyspnoea, especially when taking high doses. Because of the time relationships of the bowel and lung symptoms, we suggest that these disorders may be related.
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PMID:Chronic bronchial suppuration and inflammatory bowel disease. 726 68

A 29-year-old woman with chronic bronchial asthma and inflammatory bowel disease, previously classified as idiopathic, was hospitalized because of bouts of fever and increasing dyspnoea and diarrhoea. Chest radiograph showed extensive bilateral pulmonary infiltrates. Thought to be suffering from bacterial pneumonia she was treated with broad-spectrum antibiotic, but without improvement even after a change of antibiotics. Numerous diagnostic tests failed to find any causative organism. Subsequently she was found to have peripheral eosinophilia and pericardial effusion associated with echocardiographic and electrocardiographic signs of myocarditis, which raised the suspicion of allergic granulomatous vasculitis (Churg-Strauss syndrome). The patient's acute illness contraindicated a lung biopsy, but the clinical picture left no doubt of the true diagnosis. Treatment with methylprednisolone (initially 250 mg, then 80 mg daily) rapidly improved the clinical, radiological and biochemical findings. But four months later, under maintenance treatment with 15 mg methylprednisolone daily, she experienced another bout of colitis and, a few days later, pulmonary recurrence of the Churg-Strauss syndrome, both clinically and radiologically. The dose of methylprednisolone was raised to 60 mg daily. The inflammatory bowel disease, endoscopically manifesting as ulcerative colitis, was most likely part of the systemic vasculitis.-This case demonstrates that colitis can be the primary manifestation of Churg-Strauss syndrome.
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PMID:[Ulcerative colitis as a primary manifestation of Churg-Strauss syndrome]. 758 13

A 68-yr-old man with steroid refractory distal ulcerative colitis was treated with low-dose 6-mercaptopurine, and corticosteroids were successfully discontinued. He later presented with dyspnea and fever, was diagnosed with Pneumocystis carinii pneumonia by bronchoalveolar lavage, and died despite aggressive therapy. Serological tests for HIV were negative, and his white blood cell count was normal. This is the first report of P. carinii pneumonia complicating therapy of inflammatory bowel disease with 6-mercaptopurine. Although the mechanism is not entirely clear, 6-mercaptopurine appears to decrease cell-mediated immunity. Opportunistic infections such as P. carinii pneumonia should be added to the list of potential bronchopulmonary complications of antimetabolite immunosuppressive therapy of inflammatory bowel disease.
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PMID:An unusual complication of immunosuppressive therapy in inflammatory bowel disease. 931 88

Acute pericarditis has been described as an extraintestinal manifestation of inflammatory bowel disease (IBD), as well as a consequence of IBD treatment, specifically sulfasalazine and mesalamine. Until now, there have been no reported cases of constrictive pericarditis associated with IBD or its treatment. A 37-year-old woman with a 24-year history of chronic ulcerative colitis (CUC) presented with a 3-month history of fevers, palpitations, dyspnea, syncope, and retrosternal chest pain. Two weeks before symptoms, she had initiated oral mesalamine for an ongoing CUC flare. Physical examination suggested constrictive pericarditis. An echocardiogram revealed a thickened pericardium with a nearly circumferential fibrinous effusion, with Doppler confirming diastolic compromise. The patient proceeded to radical pericardectomy. Pathological examination showed grossly hemorrhagic acute and chronic pericarditis, with cultures and cytology negative. To date, only 104 cases of IBD with acute pericarditis have been reported, with fewer than 10 cases of mesalamine-induced acute pericarditis reported. This is the first reported case of constrictive pericarditis related to IBD or its treatment. Although our patient may have had IBD-associated constrictive pericarditis, her mesalamine use raises the possibility of a drug-induced constrictive pericarditis.
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PMID:Constrictive pericarditis in chronic ulcerative colitis. 1187 6

A 45 year old male suffered from typical exercise-induced dyspnoea and angina. Crohn's disease treated with glucocorticoids was present for 18 years. Coronary angiography revealed small left anterior descending and right coronary arteries without reference to coronary artery disease, while the main stem and circumflex artery were severely dilated due to a fistula (diameter 5.5 mm) into the coronary sinus with a left/right shunt amounting to 35%. Haemodynamics, significant risk of endocarditis with chronic inflammatory bowel disease and obligatory glucocorticoid treatment were indications for fistula closure. As an alternative to surgical correction, the coronary fistula was totally occluded by antegrade micro-coil embolization. The present report offers a review on differential therapeutic considerations and specific treatment options including novel interventional modalities for coronary fistulas.
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PMID:[Micro-coil embolization of a fistula of the circumflex ramus in the coronary sinus. Case report, differential therapy and review of the literature]. 1200 43


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