Crohn’s disease with pulmonary involvement: A rare localization

INTRODUCTION: Although joint, skin and ophthalmological involvement remain the most reported extra-digestive manifestations of Crohn’s disease, pulmonary localization is rare. We report a case of Crohn’s disease with early pulmonary involvement. CASE REPORT: This was a 24-year-old smoking patient who had consulted for multiple chest pains in a recent Crohn’s disease context. A chest CT scan showed pulmonary hypodense, lobulated nodular structures in the left and right lower lobes. The left lung nodule biopsied, revealed subacute inflammatory changes with giant cell granuloma and necrosis foci related to the Crohn’s disease after excluding tuberculosis and sarcoidosis. After initiation of anti-TNFα (adalimumab), the evolution was favorable with regression of clinical symptoms and lung lesions but at the cost of a severe psoriasis outbreak that required a change in treatment with ustekimab. CONCLUSION: The hypothesis of pulmonay localization should be mentioned in case of pulmonary symptoms from a patient followed for Crohn’s disease.