Mayo School of Graduate Medical Education Rochester, MN, United States
Thomas W. Fredrick, MD1, Ahmed T. Kurdi, MD2, Sunanda V. Kane, MD, MSPH, FACG2 1Mayo School of Graduate Medical Education, Rochester, MN; 2Mayo Clinic, Rochester, MN
Introduction: Chest pain with shortness of breath is a common chief complaint with a broad differential diagnosis. We present the second reported case of a primary spontaneous pneumothorax manifesting during a flare of ulcerative colitis.
Case Description/Methods: A 29-year-old male with history of primary sclerosing cholangitis and ulcerative colitis presented with sudden onset left sided chest pain. Two months prior, he was started on adalimumab to treat active colitis symptoms. After presenting to the clinic for symptom recurrence, he developed sudden onset stabbing chest pain and shortness of breath. In the emergency department his vital signs and physical exam were unremarkable apart from tachycardia with a heart rate of 106 beats per minute. Laboratory analysis demonstrated elevated D-dimer of 1539 ng/mL and fecal calprotectin >1000 mcg/g. Chest X-ray showed a large left-sided pneumothorax. Needle decompression followed by chest tube placement was performed and his chest pain resolved. Follow up CT scan demonstrated no evidence of bullous disease, blebs, or cystic lung disease or pulmonary embolism.
He was admitted to the hospital and given his symptom progression he was started on high-dose corticosteroids which led to improvement of his gastrointestinal symptoms.
Discussion: We present a unique case of primary spontaneous pneumothorax occurring during active ulcerative colitis. Our patient had no previous pulmonary disease, bullous findings on CT scan, or any other predisposing factors for a pneumothorax apart from active ulcerative colitis. The literature reports only one other case of inflammatory bowel disease (IBD) associated with spontaneous pneumothorax without any predisposing factors or lung pathology, which was attributed to colonic gas leak. 1
Pulmonary manifestations of IBD typically include bronchiectasis, granulomatous disease, and interstitial pneumonia. Medications (most often mesalamine, sulfasalazine and methotrexate) used to treat inflammatory bowel disease can also cause a drug-induced lung injury. Patients with active disease are at risk for thromboembolic events and use of biologics can result in infectious pneumonia.
Our patient manifests the emergent presentation of primary spontaneous pneumothorax arising in active IBD, a rare but potentially fatal pulmonary development that providers should always consider in patients with IBD.
1. Cohen ME, Kleinman MS. Pneumomediastinum during relapse of ulcerative colitis. Am J Gastroenterol 1997;92:2306-7.
Figure: Chest radiograph of our patient with active ulcerative colitis and chest pain.
Thomas Fredrick indicated no relevant financial relationships.
Ahmed Kurdi indicated no relevant financial relationships.
Sunanda Kane indicated no relevant financial relationships.
Thomas W. Fredrick, MD1, Ahmed T. Kurdi, MD2, Sunanda V. Kane, MD, MSPH, FACG2. P1673 - Spontaneous Pneumothorax During Active Ulcerative Colitis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.