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Multifactorial immunologic lung disease: a case report
J Krasnick1, R Patterson, M Roberts
1Division of Allergy-Immunology, Northwestern Memorial Hospital, Chicago, Illinois, USA.
Background:
Allergic asthma, allergic bronchopulmonary aspergillosis, and hypersensitivity pneumonitis are all forms of immunologically mediated lung disease. Recognition that more than one of these diseases may co-exist is necessary for proper patient management.
Objective:
To report a case of extrinsic (cat) asthma, allergic bronchopulmonary aspergillosis, hypersensitivity pneumonitis, and potentially fatal asthma. Immunologic mechanisms and treatment of these diseases are discussed.
Methods:
The study is a case report from a university hospital setting. Serum precipitating antibodies against avian antigens were measured using gel-diffusion technique. Serum IgE levels were measured and skin testing was performed to selected antigens.
Results:
The patient had positive cutaneous reactivity to cat antigen and Aspergillus. Serology for allergic bronchopulmonary aspergillosis and serum precipitating antibodies to finch extract were positive. Symptoms improved and prednisone requirements decreased after removal of finches.
Conclusion:
A case of cat asthma, potentially fatal asthma, allergic bronchopulmonary aspergillosis, and hypersensitivity pneumonitis is presented. Early recognition and treatment of multifactorial immunologic lung disease with avoidance measures and use of corticosteroids can prevent progressive respiratory damage.