ArticleRespirology case reports2026
Disease-Intrinsic Organising Pneumonia During Biomarker-Confirmed Ulcerative Colitis Remission.
Article in Respirology case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Organising pneumonia is an increasingly recognised pulmonary manifestation of ulcerative colitis, though nearly all reported cases are attributed to drug-induced aetiology. The 2025 ERS/ATS classification of interstitial pneumonias now explicitly lists ulcerative colitis among secondary causes of cicatricial organising pneumonia, formally recognising a disease-intrinsic mechanism for organising pneumonia in ulcerative colitis. We present a 76-year-old woman with 10-year ulcerative colitis pancolitis on stable mesalamine in biochemical remission (faecal calprotectin 62 μg/g, below the 80 μg/g histological activity threshold) who developed progressive dyspnea. Drug-induced aetiology was systematically excluded: mesalamine had been stable for 10 years, discontinuation produced no improvement, and corticosteroids were required for response. Transbronchial cryobiopsy was initially interpreted as fibrotic non-specific interstitial pneumonia; expert pathology consultation revised the diagnosis to organising pneumonia with Masson bodies, changing management from antifibrotics to corticosteroids, illustrating the clinical consequences of cryobiopsy diagnostic discordance. Bronchoalveolar lavage revealed a neutrophil-predominant profile (42% neutrophils, 3% lymphocytes), atypical for cryptogenic organising pneumonia, which typically shows lymphocytic predominance. This pattern may reflect gut-lung axis immune trafficking in secondary organising pneumonia associated with ulcerative colitis. Concurrent seronegative arthritis was reclassified as ulcerative colitis-associated spondyloarthropathy, removing rheumatoid arthritis-associated interstitial lung disease from the differential. This case extends the sole prior report of organising pneumonia during confirmed ulcerative colitis remission by incorporating biomarker-confirmed remission, systematic drug exclusion, cryobiopsy discordance with treatment-altering consequences and contextualisation within the updated 2025 ERS/ATS classification framework.
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