S4965 Ulcerative Colitis and Intestinal Lung Disease Complicated by Recurrent Enteric Infections: A Case of C. difficile and C. perfringens Bacteremia

Introduction: While extraintestinal manifestations like arthritis, asthma, psoriasis, and pericarditis are well-documented in inflammatory bowel disease (IBD), pulmonary involvement remains a relatively rare complication. However, emerging studies suggest that 28-58% of patients with IBD may have related pulmonary manifestations. This suggests an intricate interplay between the gut and lungs, often referred to as the gut-lung axis, where shared immune and microbiotic pathways may contribute to both gastrointestinal and respiratory complications. Case Description/Methods: A 65-year-old man with a medical history of moderate ulcerative colitis (UC), interstitial lung disease (ILD), and chronic obstructive pulmonary disease presented with worsening chronic diarrhea and progressive shortness of breath. He had been recently hospitalized for a UC flare, during which colonoscopy revealed pancolitis without dysplasia and segmental severe inflammation in the sigmoid and descending colon and was discharged on oral mesalamine and budesonide. Although his bowel symptoms initially improved, he relapsed experiencing 5–6 watery to profuse bowel movements per day. He reported fatigue and chills, but denied fever, abdominal, chest pain, or urinary symptoms. In the emergency department, a computed tomography abdomen and pelvis was performed, and stool testing returned positive for Clostridium difficile. He was treated with a full course of oral vancomycin and discharged. However, his symptoms worsened, now with increased shortness of breath and persistent diarrhea accompanied by hypoxia, requiring 2 L/min of supplemental oxygen. A computed tomography angiography of the chest revealed honeycombing and fibrotic changes consistent with underlying ILD. The autoimmune panel showed positive ANA but no other specific markers identified. Blood cultures later revealed Clostridium perfringens bacteremia, suspected to be secondary to bacterial translocation across compromised colonic mucosa. The patient was treated with intravenous vancomycin, intravenous corticosteroids, and metronidazole, and was admitted for further pulmonary and gastrointestinal evaluation. Discussion: Here, we report a rare case of ILD in a patient with UC, a manifestation that is often overlooked. Early recognition and intervention are crucial to prevent long-term morbidity. This case highlights the critical need for systematic ILD screening protocols in the IBD patient population to facilitate early detection and management.