Pneumothorax as a presenting feature of granulomatous disease of the lung in a patient with Crohnʼs disease

Pulmonary disease and abnormalities of pulmonary function testing have been described in patients with Crohnʼs disease. The case of a 25-year-old female presenting with pneumothorax as a complication of Crohnʼs-related granulomatous lung disease is described here. The patient presented with symptoms of dyspnoea and chest pain, a chest radiograph revealed a pneumothorax on the right side. This pneumothorax did not resolve with intercostal tube drainage. Video-assisted thoracoscopy was performed at which small blebs were observed on the surface of the lung. Histology from a resected specimen of lung tissue demonstrated noncaseating granulomas. Colonoscopy was performed to investigate synchronous iron deficiency anaemia. This showed changes typical of Crohnʼs colitis. Granulomas were identified on histological examination of colonic tissue. Although pulmonary involvement in Crohnʼs disease has become increasingly recognised, pneumothorax has not been described previously.