Diffuse Lung Disease: Diffuse Lung Disease |

One Case of Chronic Hypersensitivity Pneumonitis FREE TO VIEW

Beibei Liu, MD; Ning Shen, MD; Chun Chang, MD; Bei He, BS
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Respiratory Medicine, Peking University Third Hospital, Beijing, China

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A202. doi:10.1016/j.chest.2016.02.209
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SESSION TITLE: Diffuse Lung Disease

SESSION TYPE: Case Report Slide

PRESENTED ON: Saturday, April 16, 2016 at 05:15 PM - 06:15 PM

INTRODUCTION: Hypersensitivity pneumonitis (HP) is a complex syndrome resulting from repeated exposure to a variety of organic particles. The clinical presentation is divided into acute, subacute, and chronic forms. There is a partial overlap on imaging and pathological features between Chronic HP and NSIP/UIP, so clinicians need to raise awareness of HP, We will introduce one case of chronic Hypersensitivity pneumonitis.

CASE PRESENTATION: A 71 years old female patient was admitted with cough since Jan 2012. On Chest CT (Feb 2012) bilateral diffuse ground-glass opacity/reticular opacities were observed. Open-lung biopsy (Feb 2012) confirmed hypersensitivity pneumonitis. Then patient was accepted 40 mg/day oral prednisolone therapy, then Clinical improvement was achieved and Chest CT (Apr 2012) was better. In Oct 2012 (2 months after stop pred) patient coughed again, with the bilateral ground-glass/reticular opacities on Chest CT worsing, The patient was admitted to our hospital Dec 2012 and was treated with pred 40mg/d since Jan 2013, then cough got better. But on Jan 13, 2013, she was admitted with fever, cough, white sputum, dyspnea again. Physical examination: there were bilateral moist rales, a little wheezing. We diagnosised as HP with infection, treated with ceftazidime and levo until symptoms relieved. After 12 weeks of treatment, the pred dose decreased gradually, eventually 10mg/d maintained. There were still shortness of breath after obvious activities and Chest CT had no obvious improvement. Patients did not find a clear source of allergies.

DISCUSSION: The diagnosis of HP relies on a high level of clinical suspicion, the recognition of antecedent antigen exposure, and a constellation of clinical, radiologic, laboratory, and pathologic findings. Massive exposure and the presence of a flu-like syndrome with substantial improvement in a few hours/weeks can be quite helpful in the diagnosis acute HP. Patchy ground-glass opacities on HRCT scan and increased BAL neutrophils and lymphocytes are also important diagnostic clues. In the vast majority of subacute/chronic cases, surgical lung biopsy is required. Early diagnosis and antigen avoidance are key measures in the treatment of HP. Drug treatment is usually treated with corticosteroids. In patients with subacute progressive and chronic disease, corticosteroids may need to be sustained for more than 3 to 6 months. An empiric scheme may consist of 0.5 mg/kg/d of prednisone for 4 to 6 weeks followed by a gradual reduction until a maintenance dose of approximately 10 mg/d is reached. we analyzed premature withdrawal was the reason of symptoms repeatedly aggravated.

CONCLUSIONS: Chronic HP has a slow onset but may have progressive aggravation. We should not stop the drug prematurely in the treatment process.

Reference #1: Selman M1, Pardo A, King TE Jr. Hypersensitivity pneumonitis: insights in diagnosis and pathobiology. Am J Respir Crit Care Med.2012;186(4):314-24.

DISCLOSURE: The following authors have nothing to disclose: Beibei Liu, Ning Shen, Chun Chang, Bei He

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