Lead I Sign in ECG: An Underrecognized Truth or a Myth?

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Background: Ulcerative colitis (UC) is a multi-system inflammatory disease.UC commonly affects the distal colon and rectum, but extra-intestinal manifestations (EIM) can be seen in other systems.Respiratory involvement can involve any part of the respiratory system, but tracheitis is especially uncommon.We present a rare case of UC presenting with tracheitis.Case: A 24-year-old male with a history of psoriasis presented to the emergency department with one month of hematochezia, profuse diarrhea, and weight loss.He also endorsed a cough, chest pain, and night sweats.Labs were notable for leukocytosis, anemia, and elevated inflammatory markers.Chest CT showed tracheal inflammation and ground glass nodules.Bronchoscopy demonstrated friable lesions of the vocal cords with diffuse friable tracheal tissue.An ulcerated polypoid lesion was seen at the level of the carina (Figure 1).Biopsy of the trachea showed acute and chronic inflammation.Colonoscopy revealed pancolitis consistent with UC.He was started on systemic and inhaled corticosteroids, resulting in rapid improvement.He was discharged on prednisone with plans for infliximab therapy.Conclusion: EIM of IBD, such as arthritis and uveitis are common.Respiratory involvement is less common, and tracheitis is incredibly rare, with only a handful of case reports described.Tracheal involvement commonly presents after onset of GI disease but can happen prior to bowel involvement or after pancolectomy.Suspicion for respiratory manifestations is important in anyone with IBD.UC-associated tracheitis can be suspected based on findings from bronchoscopy, biopsy, and PFTs.Respiratory disease can be treated with corticosteroids, azathioprine, and infliximab.

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