Fibrotic Hypersensitivity Pneumonitis Diagnosed by a Re-evaluation with Bronchoalveolar Lavage at Disease Deterioration
A 79-year-old man was admitted with worsening cough, dyspnea, and increased ground-glass opacity on chest computed tomography (CT). He had been diagnosed with idiopathic pulmonary fibrosis given the absence of an identifiable cause of interstitial pneumonia, chest CT findings, and absence of lymphoc...
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| Veröffentlicht in: | Internal Medicine 2023/02/15, Vol.62(4), pp.577-582 |
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| creator | Moda, Mitsuhiro Arai, Toru Takeuchi, Naoko Kagawa, Tomoko Takimoto, Takayuki Sumikawa, Hiromitsu Shimizu, Shigeki Inoue, Yoshikazu |
| description | A 79-year-old man was admitted with worsening cough, dyspnea, and increased ground-glass opacity on chest computed tomography (CT). He had been diagnosed with idiopathic pulmonary fibrosis given the absence of an identifiable cause of interstitial pneumonia, chest CT findings, and absence of lymphocytosis in bronchoalveolar lavage (BAL) fluid. Meticulous history taking revealed extensive exposure to inciting antigens contained in chicken fertilizer before symptom worsening. A re-evaluation with BAL showed lymphocytosis, and clinical improvement with antigen avoidance confirmed the diagnosis of fibrotic hypersensitivity pneumonitis (fHP). A re-evaluation with BAL at disease deterioration after possible exposure to inciting antigen can facilitate a correct fHP diagnosis. |
| doi_str_mv | 10.2169/internalmedicine.9736-22 |
| format | Article |
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He had been diagnosed with idiopathic pulmonary fibrosis given the absence of an identifiable cause of interstitial pneumonia, chest CT findings, and absence of lymphocytosis in bronchoalveolar lavage (BAL) fluid. Meticulous history taking revealed extensive exposure to inciting antigens contained in chicken fertilizer before symptom worsening. A re-evaluation with BAL showed lymphocytosis, and clinical improvement with antigen avoidance confirmed the diagnosis of fibrotic hypersensitivity pneumonitis (fHP). A re-evaluation with BAL at disease deterioration after possible exposure to inciting antigen can facilitate a correct fHP diagnosis.</description><identifier>ISSN: 0918-2918</identifier><identifier>EISSN: 1349-7235</identifier><identifier>DOI: 10.2169/internalmedicine.9736-22</identifier><identifier>PMID: 35871594</identifier><language>eng</language><publisher>Japan: The Japanese Society of Internal Medicine</publisher><subject>Alveoli ; Alveolitis ; Alveolitis, Extrinsic Allergic - diagnostic imaging ; antigen exposure ; Antigens ; bronchoalveolar lavage ; Bronchoalveolar Lavage - methods ; Bronchoalveolar Lavage Fluid ; Bronchus ; Case Report ; Chest ; Computed tomography ; Cough ; Diagnosis ; Dyspnea ; Fibrosis ; fibrotic hypersensitivity pneumonitis ; Humans ; Hypersensitivity ; idiopathic pulmonary fibrosis ; Internal medicine ; Lavage ; Lung diseases ; Lung Diseases, Interstitial - diagnostic imaging ; Lymphocytosis ; Male ; Pneumonitis ; Respiration</subject><ispartof>Internal Medicine, 2023/02/15, Vol.62(4), pp.577-582</ispartof><rights>2023 by The Japanese Society of Internal Medicine</rights><rights>Copyright Japan Science and Technology Agency 2023</rights><rights>Copyright © 2023 by The Japanese Society of Internal Medicine</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c555t-3b84460cb96d73b059a48611461c7e05d7504df82d9af3831273a6af80de43903</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10017243/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10017243/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,881,1877,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35871594$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Moda, Mitsuhiro</creatorcontrib><creatorcontrib>Arai, Toru</creatorcontrib><creatorcontrib>Takeuchi, Naoko</creatorcontrib><creatorcontrib>Kagawa, Tomoko</creatorcontrib><creatorcontrib>Takimoto, Takayuki</creatorcontrib><creatorcontrib>Sumikawa, Hiromitsu</creatorcontrib><creatorcontrib>Shimizu, Shigeki</creatorcontrib><creatorcontrib>Inoue, Yoshikazu</creatorcontrib><title>Fibrotic Hypersensitivity Pneumonitis Diagnosed by a Re-evaluation with Bronchoalveolar Lavage at Disease Deterioration</title><title>Internal Medicine</title><addtitle>Intern. Med.</addtitle><description>A 79-year-old man was admitted with worsening cough, dyspnea, and increased ground-glass opacity on chest computed tomography (CT). He had been diagnosed with idiopathic pulmonary fibrosis given the absence of an identifiable cause of interstitial pneumonia, chest CT findings, and absence of lymphocytosis in bronchoalveolar lavage (BAL) fluid. Meticulous history taking revealed extensive exposure to inciting antigens contained in chicken fertilizer before symptom worsening. A re-evaluation with BAL showed lymphocytosis, and clinical improvement with antigen avoidance confirmed the diagnosis of fibrotic hypersensitivity pneumonitis (fHP). A re-evaluation with BAL at disease deterioration after possible exposure to inciting antigen can facilitate a correct fHP diagnosis.</description><subject>Alveoli</subject><subject>Alveolitis</subject><subject>Alveolitis, Extrinsic Allergic - diagnostic imaging</subject><subject>antigen exposure</subject><subject>Antigens</subject><subject>bronchoalveolar lavage</subject><subject>Bronchoalveolar Lavage - methods</subject><subject>Bronchoalveolar Lavage Fluid</subject><subject>Bronchus</subject><subject>Case Report</subject><subject>Chest</subject><subject>Computed tomography</subject><subject>Cough</subject><subject>Diagnosis</subject><subject>Dyspnea</subject><subject>Fibrosis</subject><subject>fibrotic hypersensitivity pneumonitis</subject><subject>Humans</subject><subject>Hypersensitivity</subject><subject>idiopathic pulmonary fibrosis</subject><subject>Internal medicine</subject><subject>Lavage</subject><subject>Lung diseases</subject><subject>Lung Diseases, Interstitial - diagnostic imaging</subject><subject>Lymphocytosis</subject><subject>Male</subject><subject>Pneumonitis</subject><subject>Respiration</subject><issn>0918-2918</issn><issn>1349-7235</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNplkU9vEzEQxVcIREPhKyBLXLhs8b9d2ycELaVIESAEZ2t2d5I42tjB9qbKt8chIYJyGcvy770Zz6sqwugVZ61543zG6GHc4OB65_HKKNHWnD-qZkxIUysumsfVjBqma17KRfUspTWlQivDn1YXotGKNUbOqvtb18WQXU_u9luMCX1y2e1c3pOvHqdN8OWayI2DpQ8JB9LtCZBvWOMOxgmyC57cu7wi72Pw_SrAuMMwQiRz2MESCeSiTQgJyQ2WoV2Iv0XPqycLGBO-OJ2X1Y_bD9-v7-r5l4-frt_N675pmlyLTkvZ0r4z7aBERxsDUreMyZb1CmkzqIbKYaH5YGAhtGBcCWhhoemAUhgqLqu3R9_t1JVt9ehzhNFuo9tA3NsAzv774t3KLsPOMkqZ4lIUh9cnhxh-Tpiy3bjU4ziCxzAly1sjJVNaqIK-eoCuw3TIqVBKt4pTwXWh9JHqY0gp4uI8DaP2EK99GK89xGs5L9KXf__mLPyTZwE-H4F1ymX9ZwBiiXjE_51bbuWhnDqcwX4F0aIXvwByzcXf</recordid><startdate>20230215</startdate><enddate>20230215</enddate><creator>Moda, Mitsuhiro</creator><creator>Arai, Toru</creator><creator>Takeuchi, Naoko</creator><creator>Kagawa, Tomoko</creator><creator>Takimoto, Takayuki</creator><creator>Sumikawa, Hiromitsu</creator><creator>Shimizu, Shigeki</creator><creator>Inoue, Yoshikazu</creator><general>The Japanese Society of Internal Medicine</general><general>Japan Science and Technology Agency</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TK</scope><scope>7U9</scope><scope>H94</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20230215</creationdate><title>Fibrotic Hypersensitivity Pneumonitis Diagnosed by a Re-evaluation with Bronchoalveolar Lavage at Disease Deterioration</title><author>Moda, Mitsuhiro ; Arai, Toru ; Takeuchi, Naoko ; Kagawa, Tomoko ; Takimoto, Takayuki ; Sumikawa, Hiromitsu ; Shimizu, Shigeki ; Inoue, Yoshikazu</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c555t-3b84460cb96d73b059a48611461c7e05d7504df82d9af3831273a6af80de43903</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Alveoli</topic><topic>Alveolitis</topic><topic>Alveolitis, Extrinsic Allergic - diagnostic imaging</topic><topic>antigen exposure</topic><topic>Antigens</topic><topic>bronchoalveolar lavage</topic><topic>Bronchoalveolar Lavage - methods</topic><topic>Bronchoalveolar Lavage Fluid</topic><topic>Bronchus</topic><topic>Case Report</topic><topic>Chest</topic><topic>Computed tomography</topic><topic>Cough</topic><topic>Diagnosis</topic><topic>Dyspnea</topic><topic>Fibrosis</topic><topic>fibrotic hypersensitivity pneumonitis</topic><topic>Humans</topic><topic>Hypersensitivity</topic><topic>idiopathic pulmonary fibrosis</topic><topic>Internal medicine</topic><topic>Lavage</topic><topic>Lung diseases</topic><topic>Lung Diseases, Interstitial - diagnostic imaging</topic><topic>Lymphocytosis</topic><topic>Male</topic><topic>Pneumonitis</topic><topic>Respiration</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Moda, Mitsuhiro</creatorcontrib><creatorcontrib>Arai, Toru</creatorcontrib><creatorcontrib>Takeuchi, Naoko</creatorcontrib><creatorcontrib>Kagawa, Tomoko</creatorcontrib><creatorcontrib>Takimoto, Takayuki</creatorcontrib><creatorcontrib>Sumikawa, Hiromitsu</creatorcontrib><creatorcontrib>Shimizu, Shigeki</creatorcontrib><creatorcontrib>Inoue, Yoshikazu</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Internal Medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Moda, Mitsuhiro</au><au>Arai, Toru</au><au>Takeuchi, Naoko</au><au>Kagawa, Tomoko</au><au>Takimoto, Takayuki</au><au>Sumikawa, Hiromitsu</au><au>Shimizu, Shigeki</au><au>Inoue, Yoshikazu</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Fibrotic Hypersensitivity Pneumonitis Diagnosed by a Re-evaluation with Bronchoalveolar Lavage at Disease Deterioration</atitle><jtitle>Internal Medicine</jtitle><addtitle>Intern. Med.</addtitle><date>2023-02-15</date><risdate>2023</risdate><volume>62</volume><issue>4</issue><spage>577</spage><epage>582</epage><pages>577-582</pages><artnum>9736-22</artnum><issn>0918-2918</issn><eissn>1349-7235</eissn><abstract>A 79-year-old man was admitted with worsening cough, dyspnea, and increased ground-glass opacity on chest computed tomography (CT). He had been diagnosed with idiopathic pulmonary fibrosis given the absence of an identifiable cause of interstitial pneumonia, chest CT findings, and absence of lymphocytosis in bronchoalveolar lavage (BAL) fluid. Meticulous history taking revealed extensive exposure to inciting antigens contained in chicken fertilizer before symptom worsening. A re-evaluation with BAL showed lymphocytosis, and clinical improvement with antigen avoidance confirmed the diagnosis of fibrotic hypersensitivity pneumonitis (fHP). 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| subjects | Alveoli Alveolitis Alveolitis, Extrinsic Allergic - diagnostic imaging antigen exposure Antigens bronchoalveolar lavage Bronchoalveolar Lavage - methods Bronchoalveolar Lavage Fluid Bronchus Case Report Chest Computed tomography Cough Diagnosis Dyspnea Fibrosis fibrotic hypersensitivity pneumonitis Humans Hypersensitivity idiopathic pulmonary fibrosis Internal medicine Lavage Lung diseases Lung Diseases, Interstitial - diagnostic imaging Lymphocytosis Male Pneumonitis Respiration |
| title | Fibrotic Hypersensitivity Pneumonitis Diagnosed by a Re-evaluation with Bronchoalveolar Lavage at Disease Deterioration |
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