ABSTRACT
Introduction: Hypersensitivity pneumonitis (HP) is a group of disorders caused by a non-atopic, immune-mediated reaction resulting from repeat exposures to an inhaled environmental allergen. Immune complex and cell mediated hypersensitivity reactions play a role in HP pathogenesis. Case Presentation: An 11-month-old female presented for evaluation of recurrent infections, uncontrolled rhinitis, cough and difficulty in breathing for several months. She experienced nine ear infections and two sinus infections requiring antibiotics and steroids. Otolaryngology evaluated her for persistent rhinitis and prescribed antihistamines without relief. Her environmental history was significant for cockatiel and parakeet birds at home. A bird fancier precipitin panel returned positive for parakeet and cockatiel. CXR revealed bilateral interstitial prominence without focal alveolar airspace disease. A CT chest was planned but could not be performed due to the COVID-19 pandemic. The birds were removed from her home and her symptoms significantly improved. Discussion: Diagnosing HP can be challenging and oftentimes remains unrecognized or diagnosed late due to its overlapping clinical picture with other childhood respiratory illnesses. The diagnosis is usually revealed through careful history of environmental exposures, presenting symptoms, supportive radiological evidence, and improvement with removal of the causative agent. Steroids may be used in an acute attack or severe cases. Avoidance of inciting agent remains the cornerstone of management of HP. Conclusion: Although considered a disease of the adult population, the fact that our patient was diagnosed with HP at 11 months highlights the importance of considering HP as in the differential diagnosis in all age groups. [Formula presented]