Clinical episodes of granulomatous pneumonitis. Repetition during four consecutive summers

From summer to mid-autumn for four consecutive years (1974 to 1977), a 50-year-old woman barber experienced cough and exertional dyspnea with sputum production. Rales were audible at the posterior lung bases bilaterally. Her chest x-ray film showed diffuse nodular shadows, and pulmonary function studies revealed markedly decreased DCO. Open chest lung biopsy was performed and granulomatous lesions with multinucleated giant cells without central necrosis were observed. Having experienced multiple episodes for four years, she ceased to show symptoms after demolishing and reorganizing her house. This case is thought to represent the typical summer-type hypersensitivity pneumonitis, which we have subsequently found to be the most prevalent form of hypersensitivity pneumonitis in Japan.