Beyond the colon in ulcerative colitis

Spontaneous pneumomediastinum and pneumothorax

Abstract

Introduction: spontaneous pneumomediastinum and pneumothorax are exceptionally rare pulmonary complications in patients with ulcerative colitis (UC), especially in the absence of intestinal perforation or prior iatrogenic event. Prompt detection is essential due to their heterogeneous clinical presentation and possible association with severe bouts of the disease.

Case presentation: We present the case of an 18-year-old male with a history of ulcerative colitis who consulted due to a moderate to severe bout characterized by profuse diarrhea and significant weight loss. During his hospital stay, he suddenly developed cervical subcutaneous emphysema and mild dyspnea. A chest computed tomography revealed spontaneous pneumomediastinum, mild pneumothorax, and extensive subcutaneous emphysema. Esophageal, tracheobronchial, and intestinal perforation were ruled out with endoscopic and imaging tests. A colonoscopy confirmed severe inflammatory activity. The patient was treated conservatively with oxygen therapy and intravenous steroids, with positive clinical and radiological progression.

Conclusions: spontaneous pneumomediastinum should be considered within the differential diagnosis of patients with active UC who develop respiratory symptoms or subcutaneous emphysema. In clinically stable patients with no perforation, conservative treatment along with aggressive control of intestinal inflammation may be a safe and effective strategy. Further studies are needed to clarify the risk factors, pathophysiology, and long-term outcomes