Hypersensitivity pneumonitis due to humidifier disease: seek and ye shall find.

STUDY OBJECTIVES: This study reports a classic case of hypersensitivity pneumonitis (HP) with classic histologic changes in lung tissue and the research used to identify the causative antigens. DESIGN: A patient with clinical, radiographic, pulmonary function abnormalities and a lung biopsy consistent with HP had no identifiable antigen exposure. SETTING: Evaluation of the patient's activities provided no suggestion of antigen exposure. Her home was evaluated. It was found that her humidifier ran continually without being cleaned but water was added periodically. MEASUREMENTS: Serologic analysis demonstrated precipitating antibodies against her humidifier water and ten antigens in the hypersensitivity lung disease serologic panel. CONCLUSION: Removal of the humidifier, cleaning of the house, and a course of prednisone resulted in the return of the patient to a normal state.

Further studies on the detection of early lung and breast carcinoma by T antigen.

We measured the cellular and humoral autoimmune response to carcinoma (CA)-associated T antigen in patients with the earliest clinical stages of lung (T1N0M0) and breast (Tis) CA. We used desialylated MN glycoprotein from healthy human erythrocytes in a single measurement of 1) delayed-type skin hypersensitivity response (DTHR-T) and 2) humoral anti-T response with a solid-phase immunoassay (SPIA-T). DTHR-T detected 19/20 lung CA and 10/12 ductal and 7/10 lobular breast CA patients. Sixteen of 18 stage T1N0M0 lung CA patients had a positive SPIA-T as did 7/8 patients with Tis breast CA. Two of 35 patients with benign lung and 11/144 with benign breast disease had a positive DTHR-T. None of 160 persons with either other non-CA diseases or healthy had a positive DTHR-T. Three of 68 such control subjects had a positive SPIA-T. The difference between CA patients and control populations is statistically highly significant.

Bleeding in patients with activated partial thromboplastin time inhibitors.

We present a case in which an activated partial thromboplastin time (aPTT) inhibitor may have significantly contributed to prolonged bleeding in a patient and review five similar cases. The possibility of an aPTT inhibitor should be considered in the evaluation of patients with unexplained prolongation of PTT and PT. Such patients may develop significant bleeding even in the absence of other hematologic abnormalities.

Angiosarcoma of the heart. Diagnosis by echocardiography.

Angiosarcoma of the heart is a rare tumor infrequently diagnosed ante mortem. The clinical presentation is usually that of pericarditis or congestive heart failure. This case report illustrates the contribution of echocardiography in suggesting the diagnosis.

Sauna-takers disease. Hypersensitivity pneumonitis due to contaminated water in a home sauna.

Daily saunas taken by a young man were followed by fever, chills, malaise, dyspnea, cough, and myalgia from six to eight hours later. Symptoms, which were related to pouring water from a sauna bucket over the heating element, progressed to chronic dyspnea and fatigue. Serial serum samples showed precipitin reactions to bucket water and extracts of bucket mold. IgG antibody activity, demonstrated by radioimmunoassay, suggested that Pullularia was a major antigen.