Ulcerative colitis and steroid-responsive, diffuse interstitial lung disease. A trial of N = 1
D. J. Balestra, S. T. Balestra and J. H. Wasson
Department of Medicine, Veterans Administration Medical and Regional Office Center, White River Junction, Vt.
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.
