Pneumonite de Hipersensibilidade Crónica: evolução de um Caso Clínico

2020 ◽  
Vol 10 ◽  
pp. 1-9
Author(s):  
Álvaro Oliveira ◽  
Filipa Aguiar ◽  
Beatriz Fernandes ◽  
Rui Rolo
Keyword(s):  
Occupational Disease ◽  
Hypersensitivity Pneumonitis ◽  
Interstitial Lung Diseases ◽  
Left Lobe ◽  
Middle Lobe ◽  
Causal Agent ◽  
Art Teacher ◽  
Allergic Alveolitis ◽  
Professional Exposure ◽  
Group Consultation

INTRODUCTION Hypersensitivity pneumonitis (PH) or extrinsic allergic alveolitis is an inflammatory interstitial lung disease caused by recurrent exposure to a variety of environmental and/ or occupational antigens by immunologically susceptible individuals. The differential diagnosis with other interstitial lung diseases (ILD) is stimulating, but essential for a correct approach and implementation of appropriate therapy. CASE REPORT We present a case of a 55-year-old female worker, non-smoker, with no important pathological personal history. She had professional exposure to multiple paints (Gouache; Acrylics; Watercolors; Oil) inherent in her profession as an art teacher since she was 23 years old. After 24 years of performing these functions, without the use of proper personal protective equipment (protective mask, gloves, goggles, appropriate uniform), she develops a persistent cough, dyspnoea and fatigue, motivating observation in pulmonology consultation. Taking into account clinical, radiological and laboratory elements, she presented suggestive alterations of interstitial pulmonary pathology, and the diagnosis of Chronic Hypersensitivity Pneumonitis was assumed in a Multidisciplinary Group Consultation later assumed and characterized as an Occupational Disease. In the follow-up, the causal agent of the disease was removed, having the worker been mobilized internally, assuming functions associated with school coordination, for which she was able to work. Since 2011 under immunosuppression therapy with Prednisolone, Azathioprine from July 2014 to August 2016 and Mycophenolate Mofetil since March 2019, having remained clinically and functionally stable until today, without the need for oxygen therapy. As complementary diagnostic tests it has a respiratory function in 2019: FEV1 51%; FVC 55%; 73% TLC. 33% DLCO; DLCO/VA: 51%. Chest CT with scattered, bilateral ground glass densification areas; some cystic images, bilaterally, corresponding to areas of bronchial ectasia/ fibrosis; traction bronchiectasis, mainly in the upper lobes and the middle lobe; reticulation areas in the anterior right pulmonary field; calcified granuloma in the lower right lobe and upper left lobe; infracentimetric nodularities at both apexes. DISCUSSION/ CONCLUSION Chronic HP is an irreversible disease. Removal of the disease-causing antigen and immunosuppressive therapy are the usual interventions in these cases. In this worker, once the relationship between the pathology and the causal agent of the disease was assumed, was assigned a definitive incapacity for the current job, having been replaced in another compatible activity within the same company. Thus, occupational health surveillance becomes essential in the prevention/ attenuation of this occupational disease.

scholarly journals Occupational Extrinsic Allergic Alveolitis in a poultry farmer

2020 ◽  
Vol 71 (1) ◽  
pp. 69-73
Author(s):  
Smărăndescu Raluca Andreea ◽  
Mircea-Constantin Diaconu ◽  
Claudia-Mariana Handra ◽  
Agripina Rașcu
Keyword(s):  
Lung Diseases ◽  
Hypersensitivity Pneumonitis ◽  
Chemical Compounds ◽  
Interstitial Lung Diseases ◽  
Risk Exposure ◽  
Low Molecular Weight ◽  
Organic Substances ◽  
Extrinsic Allergic Alveolitis ◽  
Allergic Alveolitis ◽  
The One

AbstractHypersensitivity pneumonitis is a group of inflammatory interstitial lung diseases caused by hypersensitivity immune reactions to the inhalation of various antigens: fungal, bacterial, animal protein, or chemical sources, finely dispersed, with aerodynamic diameter <5μ, representing the respirable fraction. The national register for interstitial lung diseases records very few cases of hypersensitivity pneumonitis (extrinsec allergic alveolitis), a well defined occupational disease. Although not an eminently of occupational origin, the extrinsec allergic alveolitis can occur secondary to occupational exposure to organic substances (animal or insect proteins, bacteria, fungi) or inorganic (low molecular weight chemical compounds) and the occupational doctor is a key actor in the diagnosys. The disease has chronic evolution and exposure avoidance, as early as possible, has major prognostic influence. The occupational anamnesis remains the most important step and the occupational physician is the one in charge for monitoring and detection of the presence of respiratory symptoms in all employees with risk exposure. Next, we present the case of a farmer, without other comorbidities, who develops various respiratory and systemic diseases and manifestations due to repeated exposure to animal proteins and molds, in order to review the risk factors and the consequences of exposure in poultry farms.

scholarly journals ALLERGIC ALVEOLITIS

2020 ◽  
Vol 73 (8) ◽  
pp. 1593-1599
Author(s):  
Andrzej M. Fal
Keyword(s):  
Hypersensitivity Pneumonitis ◽  
Chronic Phase ◽  
Good Prognosis ◽  
Clinical Severity ◽  
Allergic Alveolitis ◽  
First Line Therapy ◽  
Professional Exposure ◽  
Acute Form ◽  
Acute Reaction

Allergic alveolitis (AA) is a group of diseases with an immunologic background evoked by chronic antigen inhalation. The diagnosis is difficult due to the diversity and non-specific character of symptoms and different clinical severity. AA is the third most often interstitial-lung-disease, comprising 4−15% of all interstitial diseases. It’s often related to professional exposure. Farmer’s lung, a hypersensitivity pneumonitis is the most common AA. By binding precipitins to form immunologic complexes, antigens trigger an early phase acute reaction in the lung tissue thus initiating disease’s progression. In the chronic phase endolobular fibrosis located in the upper lobes prevails. Disease differs in course depending the type and time of antigen exposition. Thus, avoiding antigen exposition is the first-line-therapy. Acute form is characterized by fever, chills, dyspnea, and cough. It usually starts 4-8 hours after intensive exposure. Early diagnosis leads to a good prognosis. When the exposition to the antigen stops, acute form of AA usually self-limits within 24−48 hours. Only in severe cases 0.5−1.0 mg/kg/d (up 60 mg/d) can be required for 1−2 weeks with a subsequent dose reduction. Long-term usually leads to chronic form with more serious deteriorations, including severe dyspnea and chronic cough (it takes months-years for them to develop, however). There is no effective therapy, in rapidly progressing cases 40−60 mg/g of prednisone repeated in 4-week-cycles can be recommended. Usually it does not stop the progression, and pulmonary fibrosis followed by respiratory insufficiency develop. Symptoms duration at diagnosis and effectiveness of antigen elimination are the known prognostic factors.

scholarly journals Sooty bark disease of maples: the risk for hypersensitivity pneumonitis by fungal spores not only for woodman

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Markus Braun ◽  
Doris Klingelhöfer ◽  
David A. Groneberg
Keyword(s):  
Hypersensitivity Pneumonitis ◽  
Correct Diagnosis ◽  
Fungal Spores ◽  
Paper Mill ◽  
Complete Recovery ◽  
Interstitial Lung Diseases ◽  
Acer Pseudoplatanus ◽  
Occupational Physicians ◽  
Mould Fungus ◽  
Public Areas

AbstractIn the middle of the twentieth century, the from North America sooty bark disease (SBD) of maples was first discovered in England and has spread in the last decades in Central Europe, in particular. The trigger of SBD is the mould fungus Cryptostroma (C.) corticale. The most common infested maple is the sycamore, Acer pseudoplatanus, a common tree in woods and parks. The disease is characterised by peeling of the outer layer of the bark and brownish-black spores under the peeled off bark. These spores can cause maple bark disease (MBD) in humans, a hypersensitivity pneumonitis (HP) with similar symptoms like COPD, allergic asthma, influenza or flu-like infections and interstitial pneumonia. Persons who have intensive respectively occupational contact with infested trees or wood, e.g., woodman, foresters, sawyers or paper mill workers, are at risk in particular. Since C. corticale favours hot summers and host trees weakened by drought, SBD will increasingly spread in the future due to ongoing climate change. Consequently, the risk of developing MBD will increase, too. As with all HPs, e.g., farmer’s lung and pigeon breeder’s disease, the diagnosis of MBD is intricate because it has no clear distinguishing characteristics compared to other interstitial lung diseases. Therefore, the establishment of consistent diagnosis guidelines is required. For correct diagnosis and successful therapy, multidisciplinary expertise including pulmonologists, radiologists, pathologists and occupational physicians is recommended. If MBD is diagnosed in time, the removal of the triggering fungus or the infested maple wood leads to complete recovery in most cases. Chronic HP can lead to lung fibrosis and a total loss of lung function culminating in death. HP and, thus, MBD, is a disease with a very high occupational amount. To avoid contact with spores of C. corticale, persons working on infested wood or trees have to wear personal protective equipment. To protect the public, areas with infested maples have to be cordoned off, and the trees should be removed. This is also for impeding further spreading of the spores.

O40-1 Risk of hypersensitivity pneumonitis and other interstitial lung diseases among pigeon breeders

2016 ◽  
Author(s):  
Christine Cramer ◽  
Vivi Schlünssen ◽  
Elisabeth Bendstrup ◽  
Zara Ann Stokholm ◽  
Jesper Medom Vestergaard ◽  
...  
Keyword(s):  
Lung Diseases ◽  
Hypersensitivity Pneumonitis ◽  
Interstitial Lung Diseases

scholarly journals Non-tuberculous Mycobacterium Disease: Radiologic Manifestation in an Infant presenting with Respiratory Distress

2017 ◽  
Vol 5 (1-2) ◽  
pp. 13-20
Author(s):  
Rupesh Gautam ◽  
Maria Isabel Atienza ◽  
Maika Noda ◽  
Mariaem Andres
Keyword(s):  
Hypersensitivity Pneumonitis ◽  
Pulmonary Infection ◽  
Clinical Manifestations ◽  
Distinct Group ◽  
Middle Lobe ◽  
Air Trapping ◽  
Pulmonary Tb ◽  
Radiologic Findings ◽  
The Common ◽  
Common Manifestation

Non-tuberculous mycobacterium (NTM) comprises distinct group of organisms with lymphadenitis and pulmonary infection as the common manifestation. The diagnosis of pulmonary disease is based on clinical manifestations, radiologic findings and microbiologic culture. The classic NTM infection may be indistinguishable from pulmonary TB. Non-classic infection has predilection to the middle lobe and lingula unlike tuberculosis which is commonly seen in the upper lobes. The disease may also present as hypersensitivity pneumonitis with ground glass like opacities, centrilobular nodules and air trapping on imaging. The knowledge of imaging manifestations of NTM will aid in timely diagnosis and treatment of the disease.Nepal Journal of Radiology Vol.5(1-2) 2015: 13-20

scholarly journals Hypersensitivity pneumonitis complicated by acute respiratory viral infection

2020 ◽  
Vol 9 (3) ◽  
pp. 68-73
Author(s):  
A.S. Kontorshchikov ◽  
A.L. Chernyaev ◽  
O.A. Vasyukova ◽  
Zh.R. Omarova
Keyword(s):  
Viral Infection ◽  
Hypersensitivity Pneumonitis ◽  
Interstitial Fibrosis ◽  
Clinical Manifestations ◽  
Giant Cells ◽  
Lung Damage ◽  
Allergic Alveolitis ◽  
Multinucleated Cells ◽  
Lung Scan ◽  
Exogenous Allergic Alveolitis

The article presents a clinical case of hypersensitivity pneumonitis complicated by a viral infection in a 72-year-old woman. The introductory part provides a concise literature review on the etiology, classification, frequency, and possible complications of hypersensitivity pneumonitis. The patient’s computed tomography (CT) lung scan showed bilateral interstitial lesions. The patient was diagnosed with idiopathic pulmonary fibrosis based on the clinical manifestations and radiological findings. The autopsy revealed morphological signs of hypersensitivity pneumonitis (obliterative bronchiolitis, moderate interstitial fibrosis with honey-combing, nonspecific interstitial pneumonia, giant multinucleated cells) and viral lung damage (exudative stage of acute respiratory distress syndrome with interalveolar edema, hyaline membranes lining the alveoli, pneumocyte desquamation, and ugly giant cells). Keywords: hypersensitivity pneumonitis, exogenous allergic alveolitis, viral infection, lungs

Chronic Interstitial Pneumonitis in a 3-Year-Old Child With Hypersensitivity to Dove Antigens

PEDIATRICS ◽  
1987 ◽  
Vol 79 (6) ◽  
pp. 1027-1029
Author(s):  
STEPHEN J. WOLF ◽  
ALLAN STILLERMAN ◽  
MILES WEINBERGER ◽  
WILBUR SMITH
Keyword(s):  
Lung Biopsy ◽  
Hypersensitivity Pneumonitis ◽  
Open Lung Biopsy ◽  
Cytotoxic Agents ◽  
Extrinsic Allergic Alveolitis ◽  
Invasive Procedures ◽  
Allergic Alveolitis ◽  
Open Lung ◽  
Environmental Agents ◽  
End Stage

Chronic interstitial lung disease is an uncommon clinical entity in childhood. The onset is frequently insidious with progressive tachypnea, dyspnea, cyanosis, clubbing, weight loss, and hypoxia. More than 100 different occupational and environmental agents have been identified as causes, although two thirds of cases are reported as idiopathic.1 Assessment can involve invasive procedures such as bronchoalveolar lavage and open lung biopsy. Treatment of the idiopathic forms includes use of corticostenoids and cytotoxic agents, and response is variable with progression to pulmonary fibrosis being a common end stage. In contrast to this grim prognosis, the similar clinical pattern associated with hypersensitivity pneumonitis, also identified as "extrinsic allergic alveolitis," can be rapidly reversed if the offending antigen is identified and eliminated.

scholarly journals Presentation, diagnosis and clinical course of the spectrum of progressive-fibrosing interstitial lung diseases

2018 ◽  
Vol 27 (150) ◽  
pp. 180076 ◽  
Author(s):  
Vincent Cottin ◽  
Nikhil A. Hirani ◽  
David L. Hotchkin ◽  
Anoop M. Nambiar ◽  
Takashi Ogura ◽  
...  
Keyword(s):  
Interstitial Pneumonia ◽  
Lung Diseases ◽  
Hypersensitivity Pneumonitis ◽  
Early Death ◽  
Occupational Exposures ◽  
Interstitial Lung Diseases ◽  
Lung Function Decline ◽  
Nonspecific Interstitial Pneumonia ◽  
Immunomodulatory Therapies

Although these conditions are rare, a proportion of patients with interstitial lung diseases (ILDs) may develop a progressive-fibrosing phenotype. Progressive fibrosis is associated with worsening respiratory symptoms, lung function decline, limited response to immunomodulatory therapies, decreased quality of life and, potentially, early death. Idiopathic pulmonary fibrosis may be regarded as a model for other progressive-fibrosing ILDs. Here we focus on other ILDs that may present a progressive-fibrosing phenotype, namely idiopathic nonspecific interstitial pneumonia, unclassifiable idiopathic interstitial pneumonia, connective tissue disease-associated ILDs (e.g.rheumatoid arthritis-related ILD), fibrotic chronic hypersensitivity pneumonitis, fibrotic chronic sarcoidosis and ILDs related to other occupational exposures. Differential diagnosis of these ILDs can be challenging, and requires detailed consideration of clinical, radiological and histopathological features. Accurate and early diagnosis is crucial to ensure that patients are treated optimally.

Sign in / Sign up

Export Citation Format

Share Document