Recurrent bilateral lung infiltrates in a patient with ulcerative colitis

A 61 year-old male with a history of coronary artery disease presented in the emergency department with a 10-day history of dyspnoea in mild physical activity. He was diagnosed with ulcerative colitis (UC) 3 years ago, and 6 months earlier he started treatment with anti-tumour necrosis factor (TNF)-alpha (he had received two doses of infliximab, the first dose 2 months ago and the second dose 1 month ago) and mesalazine. 1 month after the last dose of anti-TNF-alpha and 6 months after the initiation of therapy for UC he was hospitalised due to fever and severe respiratory failure (arterial oxygen tension/inspiratory oxygen fraction: 212) in the gastroenterology department. Chest computed tomography (CT) revealed limited emphysema, bilateral ground-glass opacities and mosaic attenuation; thus, anti-TNF-alpha induced interstitial pneumonia was suspected (figure 1a, b).