PURPOSE: Hypersensitivity pneumonitis (HP) is highly variable and its diagnosis clinically challenging. To identify and analyze the clinical features of HP proved by lung biopsy and extend the experiences to guide the clinic diagnosis of the disease.
METHODS: 42 patients with the diagnosis of HP through lung biopsy during a period of about 10 years were enrolled and analyzed retrospectively. The patients could not be confirmed in clinical procedure before the lung biopsies and the clinical-radiological-pathological (CRP) diagnosis of HP was confirmed after the lung biopsies. The respiratory symptoms and signs, radiologic findings, pulmonary function measurements and serological testing results were collected and classified.
RESULTS: Of all the 42 patients, women were twice more than men. Most of them were non-smoker. The most common symptom was dry cough and most common sign was lung rales. The most onset season was Spring. The percentage of patients with increased serum TNF-α level was 87.1% and 81% patients had increase IFN-γ levels in BALF samples. About one third(15 in 21) patients demonstrated lymphocytosis in BALF. Mixed pulmonary functional abnormalities were observed in the patients but give the first place to restrictive pulmonary functional abnormality in various degrees. CT features in HP are various in different stage of the disease. Lungs biopsy showed peribronchiolar lymphocytic infiltration and poorly formed noncaseating granulomas fibrosis in lungs. Most of the patients' symptoms and lung function improved rapidly after the initiation of steroid therapy.
CONCLUSION: The best diagnosis method of HP is clinical-radiological-pathological diagnosis. When the diagnosis remains uncertain, lung biopsy should be pursued.To avoid more patients make progression to irreversible fibrosis, it is important to be aware of the various manifestations of HP for early diagnosis and treatment.
CLINICAL IMPLICATIONS: Conclusions extracted from the proven HP patients would be used for guiding the clinical diagnosis of non-biopsy patients in future.
DISCLOSURE: Jinfu Xu, No Financial Disclosure Information; No Product/Research Disclosure Information