A 22-year-old woman with a known past medical history of Crohn disease and primary sclerosing cholangitis originally was referred for pulmonary evaluation when she presented to her primary care physician with chest pain and cough. Patient denied having any weight loss, fever, chills, diarrhea, constipation, and abdominal pain. At this time, chest x-ray was done, which showed several lung nodules. Further workup was done which included a computed tomographic (CT) scan of chest showed multiple bilateral lung nodules. Her Crohn disease and sclerosing cholangitis have remained in remission and was not on therapy for Crohn disease for several years. Blood work from pulmonary office showed normal complete blood count, comprehensive metabolic panel, elevated erythrocyte sedimentation rate, positive atypical Anti-neutrophil cytoplasmic antibody (ANCA), negative antimyeloperoxidase antibody, high normal antiproteinase antibody, normal angiotensin-converting enzyme level, and negative Gold Quantiferon for tuberculosis. C-reactive protein was markedly elevated. Pulmonary function test revealed a restrictive defect with decreased diffusion capacity with a total lung capacity of 69% of predicted, FEV1 at 84%, and DLCO at 58%. Arterial blood gas done at room air showed pH of 7.45, Pco2 of 25, Po2 of 123.
Chest x-ray and CT scan showed multiple lung nodules in the upper lung lobes bilaterally (Figure 1). CT-guided lung biopsy on 1-cm pleural-based left lung nodule showed COP on pathology. Patient did not follow-up with pulmonary regarding medical treatment as scheduled and returned to hospital approximately 2 months later with complaints of chest pain, back pain, cough, fever, and chills for approximately 3 weeks and was at this time 7 to 8 weeks pregnant. Patient was started on treatment with prednisone for organizing pneumonia with lung nodules secondary to pulmonary manifestation of Crohn disease. Patient was to be monitored closely by obstetrics-gynecology and pulmonary throughout treatment during pregnancy, but patient went to another institution for follow-up.