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Weekly Chest CasesCases by Disease Category

Case No : 1271 Date 2022-02-28

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  • Courtesy of Seung-Jin Yoo, Yo Won Choi, Sang Hyun Paik, Woo Jin Lee / Hanyang University Medical Center
  • Age/Sex 70 / F
  • Chief ComplaintCough, weight loss(4kg) for 1 month
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

initial

Diagnosis With Brief Discussion

Diagnosis
Subacute hypersensitivity pneumonitis
Radiologic Findings
Figure 1. Initial CT scan shows centrilobular and diffuse ground-glass opacities in both lungs. There are some lobular areas of decreased attenuation.
Figure 2. During 10 days of admission, the patient was treated with antibiotics and steroid. In the follow-up CT scan, ground-glass opacities nearly disappeared. The patient was discharged
Figure 3. After 45 days, the patient visited the outpatient center due to dyspnea. The CT scan shows centrilobular and diffuse ground-glass opacities, which are similar to the initial CT scan.
Figure 4. After 60 days, ground-glass opacities nearly disappeared. The patient moved out to another house during the interval period.
Brief Review
Hypersensitivity pneumonitis (HP) is a pulmonary disease caused by inhalation of any of various antigens that trigger a diffuse inflammatory response in the small airways and pulmonary parenchyma. HP traditionally has been classified as manifesting in three phases: acute, subacute, and chronic. Acute HP is characterized by abrupt onset of symptoms within a few hours after heavy antigen exposure in a previously sensitized patient. Subacute HP is caused by intermittent or continuous exposure to low doses of antigen. Chronic HP results from very low-level persistent or recurrent exposure to antigen and is differentiated from subacute HP by the presence of fibrosis. The classic histological HP triad includes the following: chronic interstitial pneumonia with peribronchiolar accentuation; bronchiolitis; and non-caseating granulomas. Granulomas, however, are not present in all cases. CT findings of subacute hypersensitivity pneumonitis are patchy or diffuse ground-glass opacity, small centrilobular nodular opacities, lobular areas of decreased attenuation (mosaic attenuation).
Our patient lived in an old house with a basement and the symptoms started when she had to clean the moldy basement by herself. After treatment with antibiotics and steroid the symptom resolved and the centrilobular and diffuse ground-glass opacities on CT scan dramatically improved. When she returned to her home, the symptoms recurred. After, she moved out, and the symptom resolved, and CT finding were normalized.
Transbronchial lung biopsy was performed during the admission period. Inflammatory cells in the thickened interstitium, focal scattered granulomas with multinucleated giant cells, and patchy scattered fibroblastic plugs in alveolar sac were detected and suggest hypersensitivity pneumonitis.
References
1. Lima MS, Coletta EN, Ferreira RG et-al. Subacute and chronic hypersensitivity pneumonitis: histopathological patterns and survival. Respir Med. 2009;103 (4): 508-15.
2. Silva CI, Churg A, M
Please refer to
Case 1244 Case 1119 Case 666 Case 605 Case 462 Case 427 Case 341 Case 271 Case 59
Keywords

No. of Applicants : 113

▶ Correct Answer : 91/113,  80.5%
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - , Japan HIROAKI ARAKAWA
  • - , Japan JUN KANZAWA
  • - , China XUFGENG ZHENG
  • - Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
  • - Showa General Hospital , Japan MASAFUMI KAIUME
  • - Ajou University Hospital , Korea (South) SUNG HYUN AN
  • - Mayo Clinic , United States AKITOSHI INOUE
  • - , France ANNE-LAURE LEJEUNE
  • - , United Kingdom SAMSON KADE
  • - McGill University Health Center , Canada ALEXANDRE SEMIONOV
  • - CHCB , France LE GUEN RAPHAEL
  • - Osaka Red Cross Hospital , Japan YUSUKE UTSUNOMIYA
  • - IRSA LA ROCHELLE , France JEAN LUC BIGOT
  • - National Center of Neurology and Psychiatry , Japan MOTO NAKAYA
  • - Inje University Haeundae Paik Hospital , Korea (South) HYUNGIN PARK
  • - , Italy PAOLO BALDASSARI
  • - Tiger Gate Hospital , Japan SHIN-ICHI CHO
  • - , Japan CHIAKI SATO
  • - Ichinomiya Nishi Hospital , Japan CHIHIRO KIGUCHI
  • - Chonnam National University Hwasun Hospital , Korea (South) HONG SEOK CHOI
  • - Other , Korea (South) HWANGHEE JO
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Ajou University Hospital , Korea (South) KYUNGMIN LEE
  • - Other , Korea (South) SEONGSU KANG
  • - Scans world , India PHILSON JOSEPH MUKKADA
  • - , Korea (South) JIN YOUNG LEE
  • - , China FANG YING GEN
  • - university of montreal , Canada Andrei Bogdan Gorgos I
  • - The first affiliated Hospital of Xiamen University , China Qing Qiang Guo
  • - Korea University Ansan Hospital , Korea (South) HYO YOUNG KIM
  • - , Korea (South) KIM HYE IN
  • - Osaka University , Japan AKINORI HATA
  • - Kaneda hospital , Japan HIROFUMI MIFUNE
  • - Ajou University Hospital , Korea (South) HAEIN LEE
  • - Wonkwang University Hospital , Korea (South) HYOJOO KIM
  • - Shimada General Medical Center , Japan HAYATO NOZAWA
  • - National Center for Global Health and Medicine , Japan MASATOSHI HOTTA
  • - , Korea (South) SUNHYANG LEE
  • - , Korea (South) HYEWON CHOI
  • - , Korea (South) HYUNSEUNG LEE
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Ajou University Hospital , Korea (South) MINJI KIM
  • - Inje University Pusan Paik Hospital , Korea (South) JIYEON HAN
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Chonnam National University Hwasun Hospital , Korea (South) MYUNG WON SONG
  • - Kyoto University Hospital , Japan YASUHISA KURATA
  • - The University of Tokyo Hospital , Japan RYO KUROKAWA
  • - Ajou University Hospital , Korea (South) YOU NA KIM
  • - , Korea (South) YEONG UK HWANG
  • - , United States HIROAKI TAKAHASHI
  • - Osaka City General Hospital , Japan SHU MATSUSHITA
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
  • - Chungbuk National University Hospital , Korea (South) MIHYEON PARK
  • - Other , Korea (South) MIN A LEE
  • - Other , Korea (South) MINSU KIM
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - , Albania AN G
  • - Avrasya Hospital/ISTANBUL , Turkey MURAT ULUSOY
  • - Eskisehir Sehir Hastanesi , Turkey MURAT SAHIN
  • - AIMS , India NITHYA HARIDAS MALIYAM
  • - Azienda Ospedaliera di Cremona , Italy Pietro Sergio
  • - Other , Korea (South) SEONG WON JANG
  • - Dokkyo Medical University , Japan HIROAKI ARAKAWA
  • - Resident , India PRASHANTH A L
  • - , India PRAVIN RAJ
  • - Manipal hospital Hebbal ,Bengaluru , India PRAVIN KUMAR M
  • - Holy Family Hospital , India RAJESH GOTHI
  • - Chonnam National University Hospital , Korea (South) KIM SANG GYUN
  • - , Japan SOSUKE HATANO
  • - Other , Korea (South) KYU-CHONG LEE
  • - Kyoto University Hospital , Japan SATOSHI IKEDA
  • - Nishida Hospital , Japan SHOJI OKUDA
  • - Seoul National University Bundang Hospital , Korea (South) YOONAH DO
  • - Toranomon Hospital , Japan KAORU SUMIDA
  • - Chonbuk National University Hospital , Korea (South) DONG HAN SHIN
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - TAKANA HAYASHI
  • - The University of Tokyo Hospital , Japan HIROSHI TAKUMIDA
  • - , Japan KAZUMA TERAUCHI
  • - Dr. Wang
  • - Sotiria Hospital, Athens , Greece VASILIOS TZILAS
  • - , Japan YUMI MAEHARA
  • - College of Medicine, CHA University , Korea (South) PARK JONG WON
  • - , Japan YUKI HAYASHI
  • - Diagnose.me (BV) / Royal Perth Hospital , Australia YURANGA WEERAKKODY
  • - , Korea (South) WONJU HONG
  • - , Korea (South) HM PARK
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - algeria , Algeria ZAKARIA CHERAGA
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Correct Answer as Differential Diagnosis : 12/113,  10.6%
  • - ZIGONG TCM HOSPITAL OF CHINA , China CAO CUN YOU
  • - NIMS, HYDERABAD , India BHASKAR K
  • - Other , Korea (South) EUN HO JANG
  • - Chonbuk National University Hospital , Korea (South) JUNGHWAN KIM
  • - HHS , Canada S LEE
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - , Korea (South) HYOUNG YEOB KIM
  • - McGill , Canada MUTAZ ADNAN KHAIRO
  • - , Japan MIDORI UENO
  • - MJH , Mongolia MUNKHGEREL DAVAA
  • - Osmania Medical College, Hyderabad , India PURUSHOTHAMA RAO TUMMALA
  • - Paras hospital, Panchkula , India SHALEEN RANA
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