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[Summer-type hypersensitivity pneumonitis with remarkable obstructive impairment of pulmonary function]
1Department of Respiratory Medicine, Juntendo University School of Medicine, Tokyo, Japan.
Summary
Hypersensitivity pneumonitis can cause severe lung obstruction. This case highlights the importance of considering fungal antigens in diagnosing obstructive lung disease, especially with granulomatous inflammation.
Area of Science:
- Pulmonary Medicine
- Immunology
Background:
- Hypersensitivity pneumonitis (HP) is an immune-mediated lung disease.
- Obstructive lung disease is typically associated with conditions like asthma or COPD.
Observation:
- A 57-year-old man presented with persistent cough and dyspnea, exhibiting wheezing and severe obstructive pulmonary function.
- Initial diagnosis was bronchiolitis, but symptoms recurred after initial improvement with corticosteroids.
Findings:
- Chest CT revealed diffuse small nodules and air space opacifications.
- Bronchoalveolar lavage showed increased CD8+ T-lymphocytes, and serum analysis revealed high anti-Trichosporon antibodies.
- Lung biopsy confirmed noncaseating granulomas in bronchioles, consistent with HP and obstructive impairment.
Implications:
- This case suggests HP can manifest with significant obstructive physiology.
- Identifying specific fungal antigens, like Trichosporon, is crucial for diagnosing HP.
- Prompt diagnosis and antigen avoidance are key for managing HP and preventing lung damage.
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