B47-39 Beyond the Gut: Bronchiectasis as a Delayed Pulmonary Manifestation of Ulcerative Colitis

Abstract Introduction Bronchiectasis is a rare pulmonary manifestation of ulcerative colitis (UC) that may present years after the initial UC diagnosis and is often underdiagnosed due to years of subclinical respiratory symptoms. The prevalence of bronchiectasis as an extra-intestinal manifestation of inflammatory bowel disease is 5-12%, with greater incidence among UC than Crohn’s disease. The pathophysiology of bronchiectasis in UC involves chronic immune-mediated inflammation of both airway and intestinal mucosa, which share a common embryonic origin. Intestinal inflammation triggers systemic cytokine interactions causing irreversible bronchial wall destruction even if UC is in remission or after a colectomy. Here we present a 56 year-old woman with frequent upper respiratory infections found to have bronchiectasis secondary to UC in remission. Case Presentation Our patient is a 56 year-old woman with a history of UC in remission (diagnosed at age 15; last flare at age 46) and treated for latent tuberculosis who presented to the emergency department (ED) with hemoptysis. Over the last six months, she had three ED visits for productive cough and intermittent hemoptysis. She was diagnosed with an upper respiratory infection, pneumonia due to COVID and haemophilus influenza, and treated with an antiviral and antibiotics. She had no gastrointestinal symptoms and was not on maintenance therapy given her history of latent TB or immunosuppressive therapy after developing leukopenia on 6-mercaptopurine. Her most recent colonoscopy showed chronic active colitis. High resolution computed tomography (HRCT) chest revealed dense recurrent right lower lobe and segmental consolidations, ground-glass opacities, suspected pulmonary hemorrhage and airway occlusion superimposed on chronic bronchiectasis. Her treatment included antibiotics, initiation of airway clearance therapy, and pulmonology follow up. Discussion and Conclusion Pulmonary symptoms may develop decades after UC onset, complicating a timely diagnosis of bronchiectasis. Diagnosis of bronchiectasis in UC requires high clinical suspicion in patients with chronic productive cough or recurrent respiratory infections, supported by HRCT imaging. Up to 40% of patients remain asymptomatic despite abnormal HRCT or pulmonary function tests (PFTs). No standardized screening guidelines currently exist for detecting bronchiectasis in UC. One study found fractional exhaled nitric oxide (FeNO) analysis in combination with PFTs may detect subclinical airway inflammation earlier, which may be a future tool for early screening. In our case, earlier imaging based on frequent symptoms may have expedited diagnosis. Physicians need to have increased awareness of this extraintestinal manifestation of UC and consider definitive imaging especially in patients presenting with recurrent pneumonias. This abstract is funded by: None