Pulmonary granulomatosis in ulcerative colitis, an uncommon extraintestinal manifestation

This is an ex-smoker patient with a history of long-standing ulcerative colitis with persistent activity and refractory to several biological therapies. She has ongoing symptoms, such as bloody diarrhea, weight loss, and severe anemia that require regular intravenous iron transfusions. Despite attempts to control the disease with different medications, including Infliximab and Vedolizumab, the patient remains symptomatic and elevates markers of disease activity, such as fecal calprotectin. At follow-up, the patient presented with a chronic cough, which led to studies that revealed the presence of a hypermetabolic pulmonary nodule in the left lower lobe, suspected of primary pulmonary neoplasia, and an atypical pulmonary resection was performed. Diagnosis reveals possible respiratory granulomatous intestinal epithelial metaplasia due to histological findings in the lung, consistent with an uncommon extraintestinal manifestation in the context of uncontrolled ulcerative colitis. Finally, a change of therapeutic target with Ustekinumab was initiated due to the previous failure of anti-TNF and Vedolizumab treatments in the control of ulcerative colitis, with clinical improvement in the digestive and respiratory spheres.