Necrobiotic Pulmonary Nodules in Ulcerative Colitis: A Rare Case Report

BACKGROUND Necrobiotic pulmonary nodules represent an exceptionally rare extraintestinal manifestation of inflammatory bowel disease (IBD), comprising conditions such as Crohn's disease and ulcerative colitis. These nodules pose significant diagnostic challenges, often mimicking autoimmune pathologies like sarcoidosis, rheumatoid arthritis, and other granulomatous diseases, thereby complicating the clinical management of affected patients. The rarity and nonspecific clinical presentation of necrobiotic pulmonary nodules necessitate a reliance on a combination of radiological and histological findings for accurate diagnosis. Herein, we discuss a 36-year-old woman with necrobiotic pulmonary nodules, underscoring this rarity and application of a surgical diagnostic approach. CASE REPORT This case study describes a 36-year-old woman with ulcerative colitis who developed necrobiotic pulmonary nodules, a rare extraintestinal manifestation of IBD with initial presentation of persistent cough. Further investigations revealed multiple bilateral lung nodules through computed tomography (CT) and positron emission tomography (PET) scans. CT-guided biopsy was not conclusive; therefore, uniportal video-assisted thoracoscopic surgery (VATS) was done for histological confirmation, which indicated necrosis without evidence of malignancy or infection. CONCLUSIONS The diagnosis of necrobiotic pulmonary nodules represents a formidable challenge in clinical practice, largely attributable to their rarity and the limited number of documented cases in the medical literature, with only 7 instances reported thus far. Compounding this difficulty is their clinical and radiological similarity to various autoimmune and infectious conditions, which often leads to diagnostic ambiguity. This case study underscores the utility of VATS as a diagnostic tool that is minimally invasive in the management of necrobiotic pulmonary nodules.