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Farmer's lung in a case after bullectomy
Dirk Koschel1, Jan Holfert, Axel Rolle
1Department of Pulmonary Diseases, Fachkrankenhaus Coswig, Centre for Pulmonary Diseases and Thoracic Surgery, Coswig, Germany. dr.koschel@fachkrankenhaus-coswig.de
International Archives of Allergy and Immunology
|March 9, 2012
Summary
This case study highlights farmer's lung (FL), a type of hypersensitivity pneumonitis, presenting unusually as a giant bulla. Diagnosis was confirmed through antibody testing and a hay inhalation challenge.
Area of Science:
- Pulmonology
- Immunology
- Radiology
Background:
- Farmer's lung (FL) is a hypersensitivity pneumonitis (HP) caused by inhaling thermophilic actinomycetes found in moldy hay.
- HP typically presents with interstitial lung disease, but atypical presentations can occur.
Observation:
- A 70-year-old woman with exertional dyspnea was evaluated for a large lung bulla.
- Post-surgical lung biopsy showed follicular lymphocytic alveolitis and granulomas, suggestive of HP.
- High-resolution CT scans did not reveal typical HP radiologic features.
Findings:
- Specific IgG antibodies for FL antigens were detected.
- Bronchoalveolar lavage showed no lymphocytic alveolitis.
- An inhalation challenge with the patient's own hay was positive, confirming FL.
- A diagnosis of chronic farmer's lung was established, with the bulla as the primary manifestation.
Implications:
- Giant bullae are an unreported primary manifestation of chronic farmer's lung.
- This case expands the spectrum of clinical and radiological presentations of hypersensitivity pneumonitis.
- Highlights the importance of considering occupational exposures in diagnosing lung diseases, even with atypical findings.
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