Introduction: Hypersensitivity pneumonitis is a complex pulmonary syndrome mediated by the immune system and caused by inhalation of antigens to which the patient has been previously sensitized. From the clinical point of view hypersensitivity pneumonitis can be divided into acute/subacute, and chronic phenotypes. It is characterized by an insidious onset of cough, dyspnea, fatigue, and weight loss that develop over several weeks to a few months. Case report: A 52-year-old patient came in February 2017 with high temperature, chest tightness, dyspnea, persistent cough, hemoptysis and weight loss of more than 6 kilograms. Radiography and computerized tomography showed poorly defined small diffuse centrilobular bilateral nodules. Inspiratory crackles were detected by physical examination. Routine laboratory tests were regular. Bronchoalveolar lavage fluid analysis and lung biopsies by video-assisted thoracoscopic surgery indicated the presence of diffuse lymphocytic infiltrates and giant cells with non-necrotizing granulomas and cellular bronchiolitis. Hypersensitivity pneumonitis diagnosed. She was given 35 mg deflazacort, bronchodilators to widen the airways and etamsilat pills. We did not identify the causative agents, including home, workplace and recreational environmental factors.Conclusion: Making the correct diagnosis has critical therapeutic and prognostic implications. Patients with hypersensitivity pneumonitis should be referred to expert centers, as the overlap with other forms of interstitial lung disease may be deceiving. The mainstay in managing this illness is to avoid the causative antigen, though complete removal is not always possible.
Lacasse Y, Selman M, Costabel U, Dalphin JC, Ando M, Morell F, et al. Clinical Diagnosis of Hypersensitivity Pneumonitis. American Journal of Respiratory and Critical Care Medicine. 2003;168(8):952–8.
2.
Petrov-Kiurski M, Živanović S, Kondić-Ivanović N. Approach to the shronic obstructive pulmonarydisease (COPD) patient in general medicine. Opsta medicina. 2019;24(1–2):9–20.
3.
Kuruc V. Intersticijalne bolesti pluća. 2016;52(2):6–10.
4.
Selman M. Hypersensitivity pneumonitis. 2011.
5.
Blanchet MR, Israël-Assayag E, Cormier Y. Inhibitory Effect of Nicotine on Experimental Hypersensitivity PneumonitisIn VivoandIn Vitro. American Journal of Respiratory and Critical Care Medicine. 2004;169(8):903–9.
6.
Katzenstein AL. Surgical pathology of the non-neoplastic lung disease. 2006.
7.
Barrios RJ. Hypersensitivity Pneumonitis: Histopathology. Archives of Pathology & Laboratory Medicine. 2008;132(2):199–203.
8.
Lacasse Y, Fraser RS, Fournier M, Cormier Y. Diagnostic Accuracy of Transbronchial Biopsy in Acute Farmer’s Lung Disease. Chest. 1997;112(6):1459–65.
9.
Meyer KC, Raghu G, Baughman RP, Brown KK, Costabel U, du Bois RM, et al. An Official American Thoracic Society Clinical Practice Guideline: The Clinical Utility of Bronchoalveolar Lavage Cellular Analysis in Interstitial Lung Disease. American Journal of Respiratory and Critical Care Medicine. 2012;185(9):1004–14.
10.
Tateishi T, Ohtani Y, Takemura T, Akashi T, Miyazaki Y, Inase N, et al. Serial High-Resolution Computed Tomography Findings of Acute and Chronic Hypersensitivity Pneumonitis Induced by Avian Antigen. Journal of Computer Assisted Tomography. 2011;35(2):272–9.
11.
Silva CIS, Churg A, Müller NL. Hypersensitivity Pneumonitis: Spectrum of High-Resolution CT and Pathologic Findings. American Journal of Roentgenology. 2007;188(2):334–44.
12.
Spagnolo P, Rossi G, Cavazza A, Bonifazi M, Paladini I, Bonella F, et al. Hypersensitivity Pneumonitis: A Comprehensive Review. 2015;25(4):237–50.
13.
Hewitt MG, Miller WT, Reilly TJ, Simpson S. The relative frequencies of causes of widespread ground-glass opacity: A retrospective cohort. European Journal of Radiology. 2014;83(10):1970–6.
14.
Dragišić D, Pena Karan S, Kuruc V, Kašiković L, S. Značaj pregleda kompjuterizovanom tomografijom visoke rezolucije u dijagnostici intersticijumskih bolesti pluća. 2016;52(2):10–7.
15.
Pereira C, Gimenez A, Kuranishi L, Storrer K. Chronic hypersensitivity pneumonitis. Journal of Asthma and Allergy. Volume 9:171–81.
16.
Koschel DS, Cardoso C, Wiedemann B, Höffken G, Halank M. Pulmonary Hypertension in Chronic Hypersensitivity Pneumonitis. Lung. 2012;190(3):295–302.
17.
Lacasse Y, Girard M, Cormier Y. Recent Advances in Hypersensitivity Pneumonitis. Chest. 2012;142(1):208–17.
Buendía-Roldán I, Selman M. Immunopathology, Diagnosis, and Management of Hypersensitivity Pneumonitis. Seminars in Respiratory and Critical Care Medicine. 33(05):543–54.
20.
Thomeer MJ, Costabel U, Rizzato G, Poletti V, Demedts M. Comparison of registries of interstitial lung diseases in three European countries. 2001;32:114–8.
21.
Fink JN, Ortega HG, Reynolds HY, Cormier YF, Fan LL, Franks TJ, et al. Needs and Opportunities for Research in Hypersensitivity Pneumonitis. American Journal of Respiratory and Critical Care Medicine. 2005;171(7):792–8.
22.
Riario Sforza GG, Marinou A. Hypersensitivity pneumonitis: a complex lung disease. Clinical and Molecular Allergy. 2017;15(1).
The statements, opinions and data contained in the journal are solely those of the individual authors and contributors and not of the publisher and the editor(s). We stay neutral with regard to jurisdictional claims in published maps and institutional affiliations.
,
