A Case Report: Hypersensitivity Pneumonia

Öz

A case of hypersensitivity pneumonitis with symptoms of dyspnea and cough, with normal PA chest radiography and with the anamnesis of pigeon exposure was presented here. 66 years old male patient had complaints of dyspnea and cough since 3 months. His respiratory sounds were normal. He did not have other environmental, occupational or drug exposure history.  In thorax high resolution computed tomography (HRCT), there were centriacinar nodules in the middle and lower lobes. When his anamnesis was reevaluated,  we learned that he was cleaning up pigeon droppings from roof every week. The patient was instructed to stop having direct and indirect contact with pigeons. One month after, the patient was reevaluated. His cough and dyspnea were improved. In his followup thorax HRCT, centriacinar nodules were disappeared. We should always consider hypersensitivity pneumonitis in the patients with the complaints of dyspnea, cough, even if the PA radiography is normal; we should take the exposure history comprehensively.

 Key words: Hypersensitivity pneumonia, centriacinar nodules, tomography

Anahtar Kelimeler

• -

Bir olgu sunumu: Hipersensitivite pnömonisi

Öz

Nefes darlığı, öksürük semptomları ile gelen PA akciğer grafisi doğal olan ancak detaylı anamnezle güvercin maruziyeti öyküsü tarifleyen ve hipersensitivite pnömonisi tanısı alan olguyu sunduk. 66 yaşında erkek hasta üç aydır olan nefes darlığı, öksürük şikayetleri ile polikliniğine başvurdu. Fizik muayenesinde solunum sesleri doğaldı. Çevresel, mesleksel maruziyet ve özellikli bir ilaç kullanım öyküsü yoktu. PA akciğer grafisi normaldi. Toraks yüksek çözünürlüklü bilgisayarlı tomografi (YÇBT)’de orta ve alt loblarda daha belirgin olan yaygın buzlu cam dansitesinde sentriasiner nodüller izlendi. Hastanın evin çatısındaki güvercinlere ait atık ürünlerini haftalık temizlediği öğrenilmesi üzerine güvercinlerle direk ve dolaylı maruziyetinin kesilmesi önerildi. Bir ay sonraki kontrolünde öksürük ve nefes darlığı semptomlarında gerileme olduğu öğrenildi. Kontrol toraks YÇBT’de her iki akciğerde izlenen yaygın sentriasiner nodüllerin kaybolduğu görüldü. Nefes darlığı, öksürük gibi semptomlarla başvuran hastalarda akciğer grafisi normal bile olsa hipersensitivite pnömonisinin de olabileceği göz önünde bulundurulmalı ve hastaların maruziyet öyküsü detaylı olarak sorgulanmalıdır.

Anahtar kelimeler: Hipersensitivite pnömonisi, sentriasiner nodüller, tomografi

Anahtar Kelimeler

• Hipersensitivite pnömonisi, sentriasiner nodüller, tomografi

Kaynakça

1. Bojko T, Notterman DA, Greenwald BM, De Bruin WJ, Magid MS, God- win T. Acute hypoxemic respiratory failure in children following bone marrow transplantation: an outcome and pathologic study. Crit Care Med 1995; 23: 755-9.
2. Griffiths MH, Miller RF, Semple SJ. Interstitial pneumonitis in patients in- fected with the human immunodeficiency virus. Thorax 1995; 50: 1141-6.
3. Salvaggio JE. Immune reactions in allergic alveolitis. J Eur Respir 1991; 4: 47-59.
4. Selman M. Hypersensitivity pneumonitis: a multifaceted deceiving di- sorder. Clin Chest Med 2004; 25: 531-47.
5. Dakhama A, Hegele RG, Laflamme G, Israël-Assayag E, Cormier Y. Com- mon respiratory viruses in lower airways of patients with acute hyper- sensitivity pneumonitis. Am J Respir Crit Care Med 1999; 159:1316-22.
6. Hoppin JA, Umbach DM, Kullman GJ, et al. Pesticides and other agricul- tural factors associated with self-reported farmer’s lung among farm residents in the Agricultural Health Study. Occup Environ Med 2007; 64: 334-341.
7. Selman M, Chapela R, Raghu G. Hypersensitivity pneumonitis: Clinical manifestations, pathogenesis, diagnosis, and therapeutic strategies. Semin Respir Med 1993; 14: 353-64.
8. Morell F, Roger A, Reyes L, Cruz MJ, Murio C, Muñoz X. Birdfancier's lung: a series of 86 patients. Medicine (Baltimore) 2008; 87: 110-30.

9. Chryssanthopoulos C, Fink JN. Clinical-immunologic correlates: a dif- ferential diagnostic update. Hypersensitivity pneumonitis. J Asthma 1983; 20: 285–296.
10. Selman M, Pardo A, King TE. Concise Clinical Review Hypersensitivity Pneumonitis Insights in Diagnosis and Pathobiology. Am J Respir Crit Care Med 2012; 186: 314-24.
11. Churg A, Muller NL, Flint J, Wright JL. Chronic hypersensitivity pneu- monitis. Am J Surg Pathol 2006; 30: 201-8.
12. Lynch DA, Rose CS, Way D, King TE Jr. Hypersensitivity pneumonitis: sensitivity of high-resolution CT in a population-based study. AJR Am J Roentgenol 1992; 159: 469-72.
13. Patel RA, Sellami D, Gotway MB, Golden JA, Webb WR. Hypersensitivity pneumonitis: patterns on high-resolution CT. J Comput Assist Tomogr 2000; 24: 965-70.
14. Akashi T, Takemura T, Ando N, et al. Histopathologic analysis of sixteen autopsy cases of chronic hypersensitivity pneumonitis and compari- son with idiopathic pulmonary fibrosis/usual interstitial pneumonia. Am J Clin Pathol 2009; 131: 405-5.
15. Silva CI, Muller NL, Lynch DA, et al. Chronic hypersensitivity pneumoni- tis: differentiation from idiopathic pulmonary fibrosis and nonspecific interstitial pneumonia by using thin-section CT. Radiology 2008; 246: 288-97.
16. Selman M, Buendía RI. Immunopathology, diagnosis, and manage- ment of hypersensitivity pneumonitis. Semin Respir Crit Care Med 2012; 33: 543-54.
17. Churg A, Sin DD, Everett D, Brown K, Cool C. Pathologic patterns and survival in chronic hypersensitivity pneumonitis. Am J Surg Pathol 2009; 33: 1765-70.
18. Gayaf M, Karasu I, Çakan A, Özsöz A, Aydoğdu Z. Güvercin Besleyici Hasta- lığı (Hipersensitivite Pnömonisi) Pigeon Breeder’s Disease (Hypersensitivity Pneumonitis). Solunum Dergisi Solunum 2010; 12: 47-51.
19. Kurup VP, Zacharisen MC, Fink JN. Hypersensitivity pneumonitis. Indian J Chest Dis Allied Sci 2006; 48: 115-28.
20. Selman M. Hypersensitivity pneumonitis. In: Interstitial lung disease, 5th ed. Schwarz M, and King TE Jr, editors. Shelton, CT: People’s Medical Publishing House-USA; 2011. pp. 597-625. BULCUN ve ark.
21. Hipersensitivite Pnömonisi