Hypersensitivity pneumonitis – acceptance of the diagnosis

Hypersensitivity pneumonia (HP) is an inflammatory lung syndrome due to repetitive exposure to small organic particles. The etiological agents of the disease are diverse and can be represented by fungi, bacteria, small molecule chemical compounds, as well as proteins from animals or insects. We present the case of a 25-year-old male, who was admitted to our Pulmonology Clinic for the following symptoms: morning cough with mucosal sputum for about 2 years, moderate exertional dyspnea (mMRC 3) started for 2 months, weight loss of about 6 kg in the past 5 months and fatigue. Clinical examination revealed bilateral mid- basal crackling rales. Chest high-resolution computed tomography (HRCT) (multiple micronodular opacities, diffuse contoured, bilaterally disseminated), lung function tests (restrictive ventilatory dysfunction with decreased carbon monoxide diffusing capacity), bronchoalveolar lavage (BAL) (lymphocyte alveolitis) and serological tests (positive antibodies for pigeon heathers and dejections) pointed to the diagnosis of hypersensitivity pneumonitis. It was recommended to avoid exposure to pigeons, as the patient was a pigeon breeder. Prednisone treatment was initiated. The general condition of the patient 1 month after diagnosis had improved, the evolution being good under treatment.

Hypersensitivity pneumonitis in a teenager

Hypersensitivity pneumonitis (HP) is an interstitial lung disease (ILD), consequence of an alveolar allergic reaction against various inhaled allergens occurring in susceptible individuals, manifesting as an acute or chronic granulomatous alveolar allergic process against inflammation of the lung parenchyma. The clinical presentation can mimic acute respiratory infections (in acute form) or an idiopathic ILD (in chronic form); the diagnosis of HP is difficult if the exposure to allergen is not suspected. We present the case of a male teenager, pigeon breeder, presenting with recurrent episodes of dyspnoea and fever, initially considered and treated as pneumonia. The diagnosis of HP was based on suggestive imaging changes, lymphocytic alveolitis at bronchoalveolar lavage with a low CD4/CD8 ratio and a thorough anamnesis for exposure and positive IgG serum precipitins against pigeon debris. The patient improved over a few months only by avoiding exposure to the incriminated allergen. ILDs in children and adolescents are considered rare diseases, with HP being one of the possible causes in older children and adolescents.