Tracheobronchial stenosis as a rare extraintestinal manifestation of ulcerativecolitis: a case series with different therapeutic approaches.

Background: Ulcerative colitis (UC) is a chronic inflammatory bowel disease characterized by extraintestinal manifestations in nearly half of patients. Although pulmonary involvement has traditionally been considered rare, with a reported prevalence of less than 1%, recent studies indicate that subclinical airway abnormalities may occur in 40-60% of cases. Tracheobronchial stenosis is an uncommon but clinically significant extraintestinal manifestation that causes considerable diagnostic and therapeutic challenges. Case series: This report presents three female patients with UC who developed significant bronchial stenosis, predominantly affecting the left main bronchus. Notably, a temporal dissociation between intestinal and respiratory disease activity was observed; in two cases, airway symptoms developed years after the initial UC diagnosis, and in one case, symptoms appeared following total colectomy during intestinal disease remission. Histopathological examination consistently revealed chronic lymphoplasmacytic infiltrates and mucosal edema. Management: Therapeutic responses varied considerably, ranging from active inflammation to irreversible fibrotic remodeling. One patient, unresponsive to systemic corticosteroids, required rigid bronchoscopy with balloon dilatation to restore airway patency. Another patient experienced rapid improvement with high-dose corticosteroids administered during a UC flare, while the third demonstrated partial improvement with persistent cicatricial stenosis. Conclusion: Early identification of tracheobronchial involvement in UC is important to prevent irreversible pulmonary damage. Given the rarity of this manifestation and the absence of standardized treatment protocols, multidisciplinary management incorporating medical therapy and interventional bronchoscopy is necessary to individualize patient care.