Organising pneumonia in ulcerative colitis with primary sclerosing cholangitis: drug-related toxicity or extraintestinal manifestation?

Pulmonary manifestations of inflammatory bowel disease (IBD) are rare but clinically significant. We present a case of a man in his 20s with ulcerative colitis and primary sclerosing cholangitis (PSC), who developed exertional breathlessness, cough and systemic symptoms. Imaging revealed bilateral pulmonary nodules, and histopathology confirmed organising pneumonia. Treatment with systemic corticosteroids led to significant clinical and radiological improvement, although a relapse occurred with early steroid tapering. This case underscores the importance of recognising pulmonary complications in patients with IBD and highlights the diagnostic challenges in distinguishing drug-induced lung injury from IBD-related extraintestinal manifestations.