Crohn's Disease with Atypical Extra-Intestinal Manifestations Developing Under Treatment with Vedolizumab

Crohn's disease is a chronic inflammatory bowel disease that can affect any part of the GI tract, which is frequently associated with extra-intestinal manifestations. Pulmonary parenchymal disease is very uncommon and usually considered to be debilitating and harder to diagnose. Pulmonary granulomas are rarely described in the literature as a complication of Crohn's disease. Here, we present a patient with Crohn's disease exacerbation who developed granulomatous lung disease under treatment with vedolizumab. Our case may add evidence to the emerging theory that gut-selective biologic agents could lead to upregulation of some pro-inflammatory factors leading to the evolution of pulmonary disease.

Pulmonary parenchymal diseases are rare in Crohn's disease but they can be debilitating and life-threatening as they are usually tardily diagnosed; awareness of this association is of high value and could potentially shorten the time to a definite diagnosis.Pulmonary manifestations of Crohn's disease could be subclinical without any respiratory complaints and not diagnosed with conventional imaging modalities such as chest x-ray.Gut-selective biologic agents could lead to the emergence of extra-intestinal manifestations due to upregulation of multiple pro-inflammatory cytokines.