Seval Müzeyyen ERCİN, Abdulsamet SANDAL, Adem KOYUNCU, Gül Şerife ÖZ

Importance of The Medical History in The Diagnosis of Hypersensitivity Pneumonitis: A Case Report

Hypersensitivity pneumonitis occurs in lungs as a result of type IV hypersensitivity reaction against various types of antigens sourced from animals, plants, fungi, bacteria, or low-molecular-weight chemical agents including isocyanates or metal fumes. Although more sophisticated tests may be required for definitive diagnosis, initial suspicion may develop only if the patient’s medical history is detailed in terms of environmental or occupational exposures. Herein, we report a 32-year old male patient presented with dyspnea, dry cough, fatigue, and weight loss. Previous treatments for respiratory infections and asthma suggested by another center had failed. He was consulted to our occupational disease’s unit for any possible occupational lung disease including pneumoconiosis, due to his employment in production of stainless-steel kitchen equipment. Detailed anamnesis revealed that the patient was also a pigeon breeder. Combining both detailed anamnesis of relevant exposures and supporting findings in high-resolution computed tomography of the chest and bronchoalveolar lavage cytology, the patient was diagnosed as hypersensitivity pneumonitis in collaboration with our hospital’s multidisciplinary team for pulmonary diseases.

PDF

___

[1] Costabel U, Guzman J. Less common diseases: Hypersensitivity pneumonitis. Diffuse Lung Disease A Practical Approach London: Arnold. 2004: 203-12.

[2] Quirce S, Vandenplas O, Campo P, et al. Occupational hypersensitivity pneumonitis: an EAACI position paper. Allergy. 2016; 71(6): 765-79.

[3] Yildiz AN, Piskin TM, Alaguney ME, et al. Attitudes and behaviors of family physicians regarding occupational diseases. Archives of Environmental & Occupational Health. 2019; 74(1-2): 85-92.

[4] Lacasse Y, Selman M, Costabel U, et al. Clinical diagnosis of hypersensitivity pneumonitis. American journal of respiratory and critical care medicine. 2003; 168(8): 952-8.

[5] Shiroshita A, Tanaka Y, Nakashima K, et al. Diagnostic accuracy of specific IgG antibodies for bird fancier’s lung: a systematic review and meta-analysis. Annals of translational medicine. 2019; 7(22): 655.

[6] Vasakova M, Morell F, Walsh S, et al. Hypersensitivity Pneumonitis: Perspectives in Diagnosis and Management. Am J Respir Crit Care Med. 2017; 196(6): 680-9.

[7] Selman M, Pardo A, King TE. Hypersensitivity pneumonitis: insights in diagnosis and pathobiology. Am J Respir Crit Care Med. 2012; 186(4): 314-24.

[8] Lacasse Y, Selman M, Costabel U, et al. Classification of hypersensitivity pneumonitis: a hypothesis. International archives of allergy and immunology. 2009; 149(2): 161-6.

[9] Mohr LC. Hypersensitivity pneumonitis. Current opinion in pulmonary medicine. 2004; 10(5): 401-11.

[10] Blanchet M-R, Israël-Assayag E, Cormier Y. Inhibitory effect of nicotine on experimental hypersensitivity pneumonitis in vivo and in vitro. American journal of respiratory and critical care medicine. 2004; 169(8): 903-9.

[11] Ohtsuka Y, Munakata M, Tanimura K, et al. Smoking promotes insidious and chronic farmer’s lung disease, and deteriorates the clinical outcome. Internal medicine. 1995; 34(10): 966-71.

[12] Hirschmann JV, Pipavath SN, Godwin JD. Hypersensitivity pneumonitis: a historical, clinical, and radiologic review. Radiographics. 2009; 29(7): 1921-38.

[13] Okuno K, Kobayashi K, Kotani Y, et al. A case of hard metal lung disease resembling a hypersensitive pneumonia in radiological images. Internal Medicine. 2010; 49(12): 1185-9.

[14] Girard M, Cormier Y. Hypersensitivity pneumonitis. Current opinion in allergy and clinical immunology. 2010; 10(2): 99-103.

[15] Wells A. The clinical utility of bronchoalveolar lavage in diffuse parenchymal lung disease. European respiratory review. 2010; 19(117): 237-41.

[16] Soumagne T, Dalphin JC. Current and emerging techniques for the diagnosis of hypersensitivity pneumonitis. Expert review of respiratory medicine. 2018; 12(6): 493-507.