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Clinical Investigations: DIFFUSE LUNG DISEASE |

Hypersensitivity Pneumonitis Induced by Spores of Lyophyllum aggregatum*

Kenji Tsushima, MD; Keisaku Fujimoto, MD; Yoshitaka Yamazaki, MD; Akemi Takamizawa, MD; Toshiya Amari, MD; Tomonobu Koizumi, MD; Keishi Kubo, MD
Author and Funding Information

*From the First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan.

Correspondence to: Keishi Kubo, MD, First Department of Internal Medicine, Shinshu University School of Medicine, 3–1-1 Asahi, Matsumoto, 390-8621, Japan; e-mail: Keishik@hsp.md.shinshu-u.ac.jp



Chest. 2001;120(4):1085-1093. doi:10.1378/chest.120.4.1085
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Objectives:Lyophyllum aggregatum (LA) is called Shimeji in Japanese and is eaten commonly as a mushroom. Shimeji mushrooms are cultivated in an indoor environment all year round. This study aimed to clarify the clinical features of hypersensitivity pneumonitis (HP) induced by LA.

Patients and setting: Ten patients showed mild respiratory symptoms including dry cough, sputum, and low-grade fever. We tried to characterize the clinical features and the findings using chest high-resolution CT (HRCT), pulmonary function tests (PFTs), and BAL fluid (BALF) tests in patients with HP induced by LA. HP was diagnosed from clinical features, HRCT findings, BALF findings, lung histology, and lymphocyte stimulation tests (LSTs) for LA.

Results: Laboratory findings showed mean (± SD) elevated levels of C-reactive protein (0.78 ± 1.3 mg/dL), erythrocyte sedimentation rate (48 ± 23 mm/h), and γ-globulin (26.9 ± 7.6%). PFTs revealed a slight decrease in the percentage diffusing capacity of the lung for carbon monoxide, possibly due to the presence of epithelial granulomas in the alveoli. Although 4 of 10 patients showed normal findings on the chest radiograph (CXR), chest HRCT findings of all patients showed centrilobular small nodules and diffuse ground-glass opacities. The BALF testing revealed an increase in total cell counts, showing predominantly activated T lymphocytes. The CD4/CD8 cell ratio was significantly decreased (0.5 ± 0.3). The results of the LSTs were positive in seven of seven cases.

Conclusions: Since patients with HP induced by LA typically have mild respiratory symptoms and sometimes normal CXR findings, their conditions might remain undiagnosed. However, the chest HRCT images showed the typical subacute phase of HP.

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