[A chronic case of summer type hypersensitivity pneumonitis]

A 59-year-old woman complaining of progressive dyspnea on exertion was admitted to our hospital in August 1992. In 1983 she had experienced exertional dyspnea from August to November, then improved spontaneously. In August 1984, she was admitted to our hospital due to the recurrence of the symptom. She was diagnosed as summer type hypersensitivity pneumonitis based on the following findings, 1) detection of non-caseous granuloma by transbronchial lung biopsy, 2) detection of precipitating antibody to Trichosporon cutaneum in the serum, 3) induction of the symptom by provocation test with the fungi, 4) isolation of the fungi from her house. In spite of moving from her house after discharge, she continued to visit her former house once a week to clean it. During the period, fibrotic changes on the chest roentgenogram were slowly progressive. In August 1992, ten years after the onset, she was re-admitted to our hospital with a complaint of exacerbated dyspnea on exertion. Open lung biopsy revealed granulomatous lesions with fibrotic changes, which was compatible with chronic type hypersensitivity pneumonitis. This patient was diagnosed as a chronic case of summer type hypersensitivity pneumonitis because of the clinical course and findings of open lung biopsy as well as laboratory data at the first admission. We consider that this case offer various information in considering the mechanism of chronic progress of summer type hypersensitivity pneumonitis.