0
Correspondence |

Throw Caution to the Wind Instruments FREE TO VIEW

Craig R. Rackley, MD; Eric B. Meltzer, MD
Author and Funding Information

From the Division of Pulmonary and Critical Care, Department of Medicine, Duke University Medical Center.

Correspondence to: Eric Meltzer, MD, Duke University Medical Center, Box 102355, Durham, NC 27710; e-mail: eric.meltzer@duke.edu


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;139(3):729. doi:10.1378/chest.10-2713
Text Size: A A A
Published online

To the Editor:

We read with interest the two articles in CHEST (September 2010) from Metzger et al1 and Metersky et al2 that implicate wind instruments as a possible source of antigens triggering hypersensitivity pneumonitis (HP). We commend these authors for rigorously documenting antigen sensitization in one patient and documenting a classic clinical course of HP in another. Taken together, these articles provide evidence that suggests a causal relationship between microorganisms present in wind instruments and HP. However, we caution that overemphasizing the role of wind instruments not only stigmatizes wind instruments as a cause of lung disease but also creates a pitfall for clinicians that could cause other types of exposure and other types of interstitial lung disease to be overlooked.

As a case in point, we consulted on a 62-year-old male music teacher and professional saxophone player who sought care for a low-grade fever associated with fatigue and a dry cough. He had no other significant medical history. Physical examination was notable for bibasilar inspiratory rales. A panel of autoantibody tests was negative. Pulmonary function tests demonstrated normal spirometry, borderline lung volumes (total lung capacity, 81% predicted), and impaired diffusion capacity of the lung for carbon monoxide (62% predicted). High-resolution CT scan revealed subpleural reticulation, mild architectural distortion, and bronchiolectasis within the middle and lower lung zones. A surgical lung biopsy specimen demonstrated patchy interstitial fibrosis around the small airways accompanied by small lymphoid aggregates, multinucleated giant cells, and numerous loosely formed granulomas in a peribronchiolar distribution. This pattern was diagnostic for HP.

Upon further questioning, the patient revealed that rotting wood was removed from his home bathroom prior to the onset of symptoms, implying a likely diagnosis of “dry rot lung” that is associated with Merulius.3 Specific antibodies were not obtained at the time of the initial consultation, yet based on this history, there was little risk of reexposure. The patient was treated with a low dose of oral corticosteroids for several months, and pulmonary function improved. More importantly, he continued to play the saxophone without interruption and without extraordinary measures to clean the instrument.

Metzger F, Haccuria A, Reboux G, Nolard N, Dalphin JC, De Vuyst P. Hypersensitivity pneumonitis due to molds in a saxophone player. Chest. 2010;1383:724-726. [CrossRef] [PubMed]
 
Metersky ML, Bean SB, Meyer JD, et al. Trombone player’s lung: a probable new cause of hypersensitivity pneumonitis. Chest. 2010;1383:754-756. [CrossRef] [PubMed]
 
O’Brien IM, Bull J, Creamer B, et al. Asthma and extrinsic allergic alveolitis due to Merulius lacrymans. Clin Allergy. 1978;86:535-542. [CrossRef] [PubMed]
 

Figures

Tables

References

Metzger F, Haccuria A, Reboux G, Nolard N, Dalphin JC, De Vuyst P. Hypersensitivity pneumonitis due to molds in a saxophone player. Chest. 2010;1383:724-726. [CrossRef] [PubMed]
 
Metersky ML, Bean SB, Meyer JD, et al. Trombone player’s lung: a probable new cause of hypersensitivity pneumonitis. Chest. 2010;1383:754-756. [CrossRef] [PubMed]
 
O’Brien IM, Bull J, Creamer B, et al. Asthma and extrinsic allergic alveolitis due to Merulius lacrymans. Clin Allergy. 1978;86:535-542. [CrossRef] [PubMed]
 
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543