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A Trial of N=1

Dominic J. Balestra, MD; Suellen T. Balestra, MD; John H. Wasson, MD

JAMA. 1988;260(1):62-64.

Abstract
We describe a patient with ulcerative colitis and extracolonic manifestations in whom diffuse interstitial pulmonary disease developed that was responsive to glucocorticoid therapy one year after total proctocolectomy. The patient presented in December 1983 with a subacute course marked by cough and progressive exertional dyspnea, abnormal chest examination results, and a chest roentgenogram that revealed diffuse interstitial and alveolar infiltrates. A transbronchial biopsy specimen revealed a polymorphic interstitial infiltrate, mild interstitial fibrosis without apparent intraluminal fibrosis, and no vasculitis, granulomas, or significant eosinophilic infiltration. Within one week of the initiation of daily high-dose steroid therapy, the patient's symptoms dramatically improved; chest roentgenogram and forced vital capacity (60%) improved at a slower rate. All three measures deteriorated when alternate-day prednisone therapy was started but once again improved until the patient was totally asymptomatic, chest roentgenograms were normal, and forced vital capacity was 80% of the predicted value 2 1/2 years later.

(JAMA 1988;260:62-64)

Author Affiliations
From the Departments of Medicine (Drs D. Balestra and Wasson) and Pathology (Dr S. Balestra), Veterans Administration Medical and Regional Office Center, White River Junction, Vt; and the Departments of Medicine (Dr D. Balestra) and Family and Community Medicine (Dr Wasson), Dartmouth Medical School, Hanover, NH.

Footnotes
Reprints not available.

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