Abstract

Occurrence of bronchiectasis and bronchiolitis obliterans in patients with ulcerative colitis after colectomy after colectomy has been previously reported. A 67-year-old man was admitted to our clinic with complaints of cough, sputum, dyspnea, weakness and weight loss. The patient had undergone colectomy because of ulcerative colitis 7 months ago and following the operation his complaints began. In high resolution computerised thorax tomography images, micronoduler opacities and focal density increase compatible with ground glass image were seen at middle and lower zones, and also ectasies accompanying peribronchial thickness were seen at lower zones. Airflow limitation and findings associated with infection showed a rapid progression, Together with Acinetobacter spp. Pseudomonas aeruginosa and Staphylococcus aureus infection, DIC (disseminated intravascular coagulopathy) developed. All of his complaints improved after starting treatment with a corticosteroid (40 mg/day) and methotrexate. During the follow up period, because of the recurrence of the findings after reducing the steroid doses, corticosteroid therapy couldn’t be stopped and 15-20 mg daily doses were maintained. When continuing prednisolone 15 mg/day and methotrexate treatment, after three years, the findings conforming with invasive pulmonary aspergillosis including high fever, dyspnea, purulent sputum and rapidly progressing cavity formation and fungus ball in the cavity were developed. These findings were controlled by liposomal amphotericin B treatment continued for two months. When findings such as airway obstruction, increased sputum excretion and purulence, anemia, elevated erithrocyte sedimentation rate, C-reactive protein and hypoproteinemia suggesting an exacerbation of ulcerative colitis were seen, immunosuppressive therapy had to be started again. 30 mg prednisolone and 125 mg azothiopurine were added to the treatment and all of the findings were regressed rapidly. Since pulmonary involvement of ulcerative colitis and co-existing invasive pulmonary aspergillosis is very rare, this case is presented as a demonstrative example .