A case of hypersensitivity pneumonitis induced by particles of eggshell in a hemodialysis patient

A 38-year-old hemodialysis patient had a dry cough from the middle of December 1997. He was treated at a local hospital, but the dry cough persisted. He was admitted our hospital on January 27, 1998, with a diagnosis of interstitial pneumonitis based on a chest X-ray film. Hypoxemia (PaO2 76 Torr) was revealed despite inhaling oxygen at a rate of 7l/min. Diffuse spotty and granular shadows were detected on bilateral lung by chest computed tomography (CT). Because drug-induced pneumonitis was doubted, lymphocyte stimulating test (LST) and lymphocyte migration inhibition test (LMIT) were performed. Particles of eggshell were positive on both tests. So we diagnosed him as having hypersensitivity pneumonitis induced by particles of eggshell. Dry cough, hypoxemia and abnormal shadow on chest CT were all improved, after he stopped ingesting particles of eggshell. Eggshell particles are widely used as phosphate binder for many hemodialysis patients. Few side effects have been reported to date, but hypersensitivity pneumonitis may occur as a result.