Cause-or-effect relationship of bronchus carcinoma and inflammatory bowel disease – A case report

Background: Increased risk of neoplasia in inflammatory bowel disease (IBD) patients on combined immunosuppressant drugs is a significant problem of medical management.

Our Patient: A 66y old male patient with a 3 years history of new-onset ulcerative colitis was referred to our clinic for 2nd opinion b/o relapsing disease. Because of his smoking history and unusual late onset IBD we have revisited his diagnosis and excluded mesenteric ischaemia. Colonoscopy showed segmental involvement of the transverse colon with significant obstruction and narrowed lumen. Distally, 3 additional small involved segments were seen and perianal fistulae. Between involved segments normal colon mucosa was present. Histology confirmed Crohn's disease (CD) of the large intestine.

Combined immune-suppression with steroids and azathioprine (AZA) resulted in significant improvement, but he presented 4 weeks later with right lobe pneumonia. Antibiotics improved symptoms but concomitant herpes zoster appeared. His general condition was week, and his IBD related symptoms worsened. Again, steroids were started with gradual increase of AZA (1.5 to 2.0mg/bw) that resulted in complete remission, at last. Weeks later he presented, again with shortness of breath confirmed as pneumonia relapse. Chest CT this time was unapparent. Again, symptoms resolved after antibiotics.

3 months later, he presented with relapse of CD, while on 2mg/bw AZA and 4mg methyl-prednisone. 5mg/ttkg Infliximab induction resulted in complete clinical remission.

2 months later chest CT was performed because of relapse of his pneumonia revealing right central bronchus carcinoma. Bronchoscopy and histology proved planocellular carcinoma. The patient was not eligible for chemotherapy or surgical care b/o concurrent IBD, DVT and distant bone metastases and died 4 months later.

Conclusion: Late onset IBD maybe a consequence of an underlying disease with high TNF levels, including cancer that warrants extensive diagnostic workup prior to starting immune suppression.