B-Lymphocyte aggregates in alveoli from a child with hypersensitivity pneumonitis (bird breeders lung)

Hypersensitivity pneumonitis is an interstitial lung disease mediated through a patient's immunologic response to a variety of inhaled organic dusts. Studies of the cellular components of lavage fluid from patients with this disease show marked increases of CD8 + suppressor/cytotoxic T-lymphocytes. In this study, we identified, in addition to the expected suppressor T-cells and natural killer cells, follicle-like aggregates of B-cells in the lung interstitium of an affected patient. The patient was an 11-year-old non-asthmatic, Caucasian male who presented with a 4-month history of progressive dyspnea, cough, and fever. The home contained nine cockatiel and two doves. Admission pulmonary functions revealed a restrictive pattern with diminished diffusion capacity. Prior to a diagnosis, the patient underwent bronchoalveolar lavage and transbronchial biopsy. Serum precipitins were eventually positive to pigeon (which cross-reacts with dove) droppings. The symptoms resolved after a prolonged course of prednisone. Analysis of bronchoalveolar lavage lymphocyte population revealed a predominance of CD8 + cells (50%) with 85% expressing the activation marker HLA-DR. The percentage of CD4 + and CD56 + were 32% and 16%, respectively. The transbronchial biopsy revealed CD20 + follicle-like aggregates within the lung interstitium. The histopathologic findings confirm that in hypersensitivity pneumonitis, the predominant immune response is an infiltrate of CD8 + T cells. The presence of B cell aggregates, however, may indicate that the local synthesis of antibody may be involved in an antibody-dependent cellular cytotoxic mechanism.