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Published in Ken Addley, MCQs, MEQs and OSPEs in Occupational Medicine, 2023
Hypersensitivity pneumonitis (extrinsic allergic alveolitis) is caused by a significant number of allergens. Acute hypersensitivity pneumonitis is associated with significant systemic symptoms of fever and so forth as well as respiratory symptoms. Bacterial overgrowth of metal working fluid (often with pseudomonas or mycobacterial species) is a common cause. The fluid is commonly collected in a sump and subsequently recycled throughout the work area with the result that it can often produce outbreaks leading to symptoms in multiple workers.
Respiratory disease
Published in Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan, Essential Notes for Medical and Surgical Finals, 2021
Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan
Hypersensitivity pneumonitis: inhalation of substances, usually spores or avian proteins (farmer’s lung, bird fancier’s lung), causes a hypersensitivity pneumonitis (type III or IV reaction). Acutely, patients have fever and SOB. Histologically, fibrosis occurs.
Hypersensitivity Pneumonitis
Published in Lourdes R. Laraya-Cuasay, Walter T. Hughes, Interstitial Lung Diseases in Children, 2019
In the chronic form of hypersensitivity pneumonitis, the symptoms include progressive shortness of breath which may be associated with mucopurulent sputum production, anorexia, and weight loss.14 As exposure to offending organic dusts continues, progressive pulmonary disability occurs and, in some cases, progresses even after institution of avoidance measures.26 With progression of the pulmonary disease, fibrosis with parenchymal contraction and honeycombing, characteristic of end-stage chest pulmonary disease, may be seen on chest roentgenograms.
Interstitial lung disease
Published in Canadian Journal of Respiratory, Critical Care, and Sleep Medicine, 2021
Bolstering the momentum behind precision diagnostics is the recent publication of the American Thoracic Society/Japanese Respiratory Society/American Lung Association of Texas (ATS/JRS/ALAT) clinical practice guideline for the diagnosis of hypersensitivity pneumonitis.6 One of the key features is a classification shift away from acute/subacute/chronic hypersensitivity pneumonitis toward two new categories: non-fibrotic or fibrotic hypersensitivity pneumonitis (HP). The approach to interpreting radiology and pathology is centered on this framework and the driver behind the evolution is the understanding that presence of fibrosis signifies a worse prognosis. Two notable suggestions in the workup of HP include a low confidence suggestion to perform bronchoalveolar lavage (BAL) with lymphocyte cellular analysis and transbronchial biopsy (TBBX) in the evaluation of non-fibrotic HP, while combining BAL lymphocyte cellular analysis with bronchoscopic lung cryobiopsy (BLC) in the evaluation of fibrotic HP. The inclusion of a flowchart addressing history of clinical exposure, presence or absence of bronchoalveolar lavage lymphocytosis (committee consensus threshold of 30% to differentiate HP from non-HP ILD), radiographic features, and histopathologic features is particularly useful for unifying the approach to MDD diagnostic confidence.
Refractory isolated pulmonary capillaritis rescued by rituximab
Published in Modern Rheumatology Case Reports, 2018
Stuart Clarence Wiber, Shahin Jamal, Kun Huang
A 47-year-old healthy man presented to hospital with 1-week history of dyspnoea and haemoptysis in 2013 brought on by two massive fine sawdust exposures. His physical examination was entirely unremarkable except for increased work of breathing and decreased oxygen saturation to 90% on room air. The chest computed tomography (CT) revealed bilateral peribronchial consolidation, centrilobular ill-defined pulmonary nodules in the upper lobe and confluent ground glass in the lower lobes, in keeping with alveolar haemorrhage. The differential diagnosis includedHypersensitivity pneumonitis from sawdust exposure.Systemic vasculitis such as anti-neutrophil cytoplasmic antibodies (ANCA) associated vasculitis (AAV) and immune complex small vessel vasculitis.Vasculitis-associated systemic diseases including connective tissue diseases and primary antiphospholipid syndrome.Drug associated vasculitis.Pulmonary or systemic infections.Valvular heart disease such as mitral stenosis.
Current best clinical practices for monitoring of interstitial lung disease
Published in Expert Review of Respiratory Medicine, 2022
Elisabeth Bendstrup, Sissel Kronborg-White, Janne Møller, Thomas Skovhus Prior
Comorbidities in patients with IPF are common and have been reported in up to 90% of patients although prevalence estimates show considerable variation [102] for individual diseases. Comorbidities are also frequent in other types of ILD, although fewer data is available. In a cohort of 211 patients with hypersensitivity pneumonitis, 90% of patients had at least one comorbidity, and a mean number of three comorbidities [103]. The heterogeneity in different studies likely reflects different approaches for the underlying studies, e.g. cohort vs. cross-sectional studies, single- or multicenter retrospective studies vs. registry studies, different diagnostic strategies or different populations like newly referred vs. pretransplant ILD patients.