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Imaging Features of Systemic Sclerosis-Associated Interstitial Lung Disease
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[Chronic Farmer's lung disease with emphysema]
T Soumagne1, B Degano2, J C Dalphin1
1Service de pneumologie, hôpital Jean-Minjoz, 2, boulevard Fleming, 25030 Besancon cedex, France.
Revue Des Maladies Respiratoires
|April 8, 2015
Summary
Farmer's lung (FL), a common hypersensitivity pneumonitis (HP), may lead to emphysema. Exposure type influences HP outcomes, suggesting a new classification based on exposure patterns and disease evolution.
Area of Science:
- Pulmonary Medicine
- Immunology
- Occupational Lung Diseases
Background:
- Farmer's lung (FL) is the most prevalent form of hypersensitivity pneumonitis (HP), affecting 0.5-1.5% of dairy farmers.
- While fibrosis is a known chronic FL sequela, an increased risk of emphysema is also observed.
Observation:
- A case of FL in a 37-year-old patient presented with typical symptoms, lymphocytic alveolitis, and CT findings.
- The patient developed early pulmonary emphysema, likely due to intermittent, massive exposure to antigens and microorganisms.
Findings:
- The current HP classification lacks consideration for exposure patterns and disease progression.
- Prognosis and evolution of HP are significantly influenced by the type and pattern of allergen exposure.
Implications:
- A proposed new classification distinguishes between massive, intermittent exposure (e.g., FL) leading to emphysema, and chronic low-level exposure (e.g., bird fancier's lung) leading to fibrosis.
- This highlights the critical role of exposure characteristics in determining HP outcomes and guiding patient management.
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