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Pediatric Hypersensitivity Pneumonitis: Clinicopathologic Characteristics of Two Cases with Fungal Triggers

Catherine Gonsalves1, Dima Ezmigna2, Archana Shenoy3

  • 1University of Florida College of Medicine, Department of Pathology, Gainesville, FL, USA.

Fetal and Pediatric Pathology
|July 4, 2020
PubMed

Insights

Hypersensitivity pneumonitis (HP) is rare in children and often misdiagnosed. Early diagnosis and steroid treatment can lead to symptom resolution in pediatric HP cases.

Area of Science:

  • Pediatric Pulmonology
  • Immunology
  • Radiology

Background:

  • Hypersensitivity pneumonitis (HP) is uncommon in pediatric populations.
  • Clinical presentations like asthma or pneumonia can delay HP diagnosis in children.

Observation:

  • Two pediatric cases (6-year-old male, 5-year-old female) of HP are presented.
  • Both cases showed negative infectious work-ups and patchy ground-glass opacities on CT scans.
  • Lung biopsies revealed lymphocytic bronchiolitis with granulomatous inflammation.

Findings:

  • Serology identified precipitins to Thermoactinomyces and Aspergillus species (Case 1) and Aspergillus fumigatus (Case 2).
  • Both patients responded well to steroid therapy, achieving symptom resolution.

Implications:

  • Consider HP in pediatric lung biopsies with granulomatous inflammation when infections are ruled out.
  • Integrating clinical, imaging, and lab data is crucial for timely pediatric HP diagnosis.

Keywords:
fungal triggershypersensitivity pneumonitispediatric pathologypulmonary pathology

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