Hypersensitivity Pneumonia Due to Lentil Aspiration: A Rare but Painstaking Pulmonary Illness

Area of Science:

• Pediatric Pulmonology
• Allergy and Immunology
• Diagnostic Medicine

Background:

• Recurrent pneumonia in infants can be challenging to diagnose, often requiring extensive investigation.
• Broad-spectrum antibiotics and antifungals may fail to resolve pneumonia if the underlying cause is not identified.
• Primary immune deficiency disorders (PID), cystic fibrosis, and infections are common differential diagnoses.

Observation:

• A 7-month-old infant presented with progressively worsening pneumonia unresponsive to standard treatments.
• Initial extensive workup, including screening for PID, cystic fibrosis, tuberculosis, and other infections, was inconclusive.
• A history of forceful feeding of lentil-based khichuri during weaning was noted upon re-evaluation.

Findings:

• The infant was diagnosed with hypersensitive pneumonia due to lentil aspiration.
• Diagnosis was confirmed by elevated IgG levels specific to lentil antigen.
• This highlights a rare form of food-related environmental lung disease in infants.

Implications:

• Highlights the importance of a detailed dietary and feeding history in pediatric respiratory cases.
• Suggests lentil aspiration as a potential cause of refractory pneumonia in infants.
• Demonstrates the efficacy of prompt steroid treatment for lentil-induced hypersensitive pneumonia.