Time-course changes in KL-6, SP-D, HRCT, DLCO, and BALF lymphocyte count were observed during the recovery phase of acute hypersensitivity pneumonitis to investigate the usefulness and limitation of these markers with regard to evaluate disease activity and therapeutic effects.
These markers were observed in 2 patients, one with acute bird fancier's lung and the other with summer-type hypersensitivity pneumonitis.
Case 1 was a 52-year-old male admitted because of fever, cough, and exertional dyspnea persisting for 1 month. Chest CT showed ground-glass opacities with a mosaic pattern and centri-lobular nodules in both lung fields. He had kept 12 pigeons for 5 years. BALF lymphocyte count was 72%, and anti-PDE antibody was positive in serum and BALF. The KL-6 and SP-D levels were 7,830 U/ml and 308 ng/ml, respectively. Avoidance of the antigen and steroid treatment improved the symptoms and imaging findings. Normalization of the levels required 8 and 18 months, respectively, along with which the %DLCO value also slowly improved. The BALF lymphocyte count was 7% at 28 months. Case 2 was a 52-year-old male admitted because of fever, cough, and exertional dyspnea for 2 months. He lived in a wooden house for 16 years. Chest CT revealed Ground-glass opacities with a mosaic pattern in both lung fields. The KL-6 and SP-D levels were 2,860 U/ml and 969 ng/ml, respectively, and the BALF lymphocyte count was 71%. BALF anti-Trichosporone asahii antibody was positive. After he moved, five and 4 months were required to normalize the SP-D and KL-6 levels, respectively, along with which the %DLCO value also slowly improved. However, the BALF lymphocyte count was still high (42%) at 4 months.
KL-6 and DLCO may have reflected the disease activity, being useful to evaluate therapeutic effects. The repair mechanism may continue for a very long time when a high BALF lymphocyte count persists.
A high KL-6 level and BALF lymphocyte count may have reflected persisting alveolitis. KL-6 and DLCO may have reflected the disease activity.
Tadashi Takao, No Financial Disclosure Information; No Product/Research Disclosure Information