BIRD FANCIERS LUNG: A CASE OF HYPERSENSITIVITY PNEUMONITIS IN AN OTHERWISE HEALTHY 51-YEAR-OLD WOMAN

ABSTRACT

SESSION TITLE Occupational and Environmental Lung Disease Case Posters SESSION TYPE Case Report Posters PRESENTED ON 10/17/2022 1215 pm - 0115 pm INTRODUCTION: Hypersensitivity Pneumonitis (HP) one of the most common interstitial lung diseases (ILD) and is caused by an allergic reaction to an inciting agent in the airway of a susceptible individual1. The diagnosis is challenging as many of the classic symptoms, dyspnea and fatigue, are nonspecific. An accurate diagnosis involves careful history taking, physical exam, pulmonary function tests (PFTs), chest computed tomography (CT) imaging, and lung biopsy. CASE PRESENTATION Patient is a 51 year old female with no PMH presents to clinic with worsening dyspnea and nonproductive cough. Symptoms began 6 months ago. She could not identify any triggers and was prescribed steroids and antibiotics with minimal relief. The patient has never smoked, denies drug use but had two pigeons. During the COVID pandemic she admitted to staying indoors more often and was not nearly as active outdoors as before. She denied fevers, chills, night sweats and weight loss. CXR showed no focal infiltrates, sharp costophrenic angels with no evidence of acute pathology. PFT's showed FVC pre 1.78, FVE1 pre 1.35, FVE1 % predicted pre 48%, FEV1/FVC pre 76%, TLC pre 3.23, VC pre 2.06 and a DLCO pre 10.98 with her LLN of 16.59. FVC post 1.91, FEV1 post 1.57, FVE1 % predicted post 58%, FEV1/FVC post 82% (Fig 1). She had positive pigeon serum antibodies. CT chest showed faint diffuse ground glass opacities bilaterally with mild mosaic attenuation reflecting HP (Figs 2, 3). The patient was diagnosed with HP, started on steroids and surrendered her pigeons with resolution of her symptoms. DISCUSSION: Diagnosis of HP is challenging as the classic symptoms of dyspnea and fatigue can be nonspecific. Physicians should be aware about increasing exposures to home antigens during the COVID pandemic in patients who have been indoors for prolonged periods of time. PFTs show a restrictive pattern and DLCO impairment. CT show the presence of centrilobular nodules, ground-glass opacities, mosaic attenuation/perfusion and air trapping and in longstanding disease there can be honeycombing and traction bronchiectasis2. Mainstay treatment is antigen avoidance and corticosteroids. Identification and complete avoidance of the antigen is the mainstay of treatment. Antigen avoidance is critically stressed as repeated exposures can result in HP progression and avoidance of the antigen is associated with improved lung function1. Corticosteroid initiation in progressive patients resulted in a reversal with an improvement of lung function3. Corticosteroids are often used in non-fibrotic HP however its efficacy remains unclear as long term prognosis has never been studied1. CONCLUSIONS: Physicians should recognize that prolonged time indoors, that have been exacerbated during the COVID19 pandemic, can increase the time patients are exposed to home antigens thus a prompt diagnosis and strict avoidance of the antigen is required to prevent irreversible damage. Reference #1 Maria Laura Alberti, "Hypersensitivity Pneumonitis Diagnostic and Therapeutic Challenges". Frontiers in Medicine, Front. Med., 23 September 2021 ;https//doi.org/10.3389/fmed.2021.718299 Reference #2 Zompatori M, Calabrò E, Chetta A, Chiari G, Marangio E, Olivieri D. Chronic hypersensitivity pneumonitis or idiopathic pulmonary fibrosis? Diagnostic role of high resolution Computed Tomography (HRCT). Radiol Med. 2003 Sep;106(3)135-46. English, Italian. PMID 14612834 Reference #3 De Sadeleer LJ, Hermans F, De Dycker E, Yserbyt J, Verschakelen JA, Verbeken EK, Verleden GM, Wuyts WA. Effects of Corticosteroid Treatment and Antigen Avoidance in a Large Hypersensitivity Pneumonitis Cohort A Single-Centre Cohort Study. J Clin Med. 2018 Dec 21;8(1)14. doi 10.3390/jcm8010014. PMID 30577667;PMCID PMC6352061. DISCLOSURES No relevant relationships by Aryeh Bernstein No relevant relationships by Thai Donenfeld No relevant relationships by Lourdes Marie F aminiano