[
    {
        "id": "osp-2793",
        "type": "article-journal",
        "title": "Unusual Cause of Lung Nodules in an Adolescent",
        "author": [
            {
                "family": "Al Rawahi",
                "given": "Yusriya"
            },
            {
                "family": "Al Jabri",
                "given": "Majid"
            },
            {
                "family": "Raniga",
                "given": "Sameer"
            },
            {
                "family": "Al Bahri",
                "given": "Maiya"
            },
            {
                "family": "Al Jamei",
                "given": "Adawiya"
            },
            {
                "family": "Rahmatallah",
                "given": "Dafalla"
            }
        ],
        "URL": "https://omanscience.com/en/articles/unusual-cause-of-lung-nodules-in-an-adolescent",
        "language": "en",
        "issued": {
            "date-parts": [
                [
                    2024
                ]
            ]
        },
        "container-title": "Oman Medical Journal",
        "DOI": "10.5001/omj.2024.97",
        "publisher": "Oman Medical Specialty Board",
        "ISSN": "1999-768X",
        "abstract": "A previously healthy 13-year-old female patient presented with a nine-month history of weight loss (20% of body weight), lethargy, anorexia, and iron-deficiency anemia. The symptoms were associated with brief intermittent chest pain and palpitations but not with exertional dyspnea or a chronic cough. On examination, she had mild conjunctival pallor. The patient’s weight was 32 kg (below the 3rd percentile), the height was 151 cm (at the 25th percentile), and the body mass index was 14 kg/m2 (below the 3rd percentile). The patient had a resting tachycardia at 120 beats/min, with all other vital signs within normal ranges. Eye examination revealed bilateral intermediate uveitis. Cardiovascular and chest examinations were unremarkable. Blood investigations revealed a low hemoglobin level of 10 g/dL (reference range = 11–14.5 g/dL) with microcytic hypochromic anemia and an increased red-cell distribution width. The platelet count was high at 800 × 10^9/L (reference range = 150–450 × 10^9/L). There was a mildly elevated total white cell count of 18 × 10^9/L, with a predominant neutrophilia of 12.3 × 10^9 (reference range = 2.4–9.5 × 10^9/L). The eosinophil count was also elevated at 1.2 × 10^9/L (reference range = 0.2–0.8 × 10^9/L). She had elevated C-reactive protein and erythrocyte sedimentation rate levels of 7 mg/L (reference range = 0–5 mg/L) and 32 mm/hour, respectively. Additionally, she had iron-deficiency anemia, low vitamin D levels of 9 ng/mL (reference range = 50–100 ng/mL), and normal vitamin B12 and folate levels. Albumin levels were low at 26 g/L (reference range = 38–54 g/L), with normal liver transaminases. The patient underwent esophagogastroduodenoscopy and colonoscopy. The esophagogastroduodenoscopy was normal, but colonoscopy revealed moderate pancolitis involving the left side of the colon. Histological examination of a colonic biopsy was consistent with ulcerative colitis. Magnetic resonance enterography showed a mild circumferential mural thickening with hyperenhancement of the left colon. However, the visualized lung bases showed a few bilateral nodules. The chest computed tomography (CT) revealed multiple bilateral irregular pulmonary nodules with halo and feeding vessel signs. Informed consent was obtained from the patient’s father. The nature of these nodules raised concerns about whether they were due to an infectious or inflammatory process, such as systemic vasculitis. Before initiating immunosuppressive therapy, the patient underwent a CT-guided lung biopsy to rule out any infectious causes. Histology of the lungs revealed expanded alveolar spaces filled with fibroblastic plugs formed by spindle-shaped fibroblasts set in a matrix of loose collagen. The inter-alveolar septa were expanded by mixed inflammatory cells in areas showing perivascular accentuation. No fibrinoid necrosis, fibrin thrombi, or granulomas were observed, and the biopsy was negative for fungal organisms. After excluding infectious causes and systemic vasculitis, the lung findings were attributed to a rare extraintestinal manifestation of IBD, suggestive of organizing pneumonia. The patient was started on oral prednisolone and mesalazine for the IBD. However, the symptoms continued along with elevated inflammatory markers, so an infliximab infusion was initiated, which led to significant clinical and biochemical improvements. Since then, the patient has been on a regular eight-weekly infliximab infusion. A repeated chest CT revealed the resolution of the lung nodules."
    }
]