Discussion
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
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- Keywords
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