An asthmatic bird lover with dyspnoea and ground glass opacities (hypersensitivity pneumonitis)

Abstract

We admitted this patient for bronchoalveolar lavage (BAL) which showed a lymphocytic alveolitis which is usually found in HP and we measured serum bird specific IgG antibodies (precipitins). Levels of IgG antibodies (precipitins) were elevated. Previously measured IgE levels were low (it is well known that HP is a non-IgE mediated hypersensitivity). She gave her bird reluctantly away and recovered fully within five weeks in the absence of exposure to her pet. Ggo’s were also completely reversible after removal from exposure. Reed et al. described the first avian-associated HP in a pigeon breeder, in 1965 [1]. Chronic repetitive exposure to different inhaled antigens such as bird excreta (droppings), and feathers of different birds, increases the risk for hypersensitivity pneumonitis [2]. Wind instrument players or even users of continuous positive airway pressure equipment could develop HP [3, 4]. There is no diagnostic gold standard, so the current diagnosis depends on symptoms (cough, dyspnea) in a person exposed to environmental antigens, HRCT with bilateral, ground glass opacities in lower and the middle zones, bronchioloalveolar lavage fluid with lymphocytic alveolitis and high levels of IgG antibodies (precipitins).