A Pigeon Fancier’s Lung; Subacute on Chronic Hypersensitivity Pneumonitis

A Peiris

doi:10.4038/jrcs.v25i1.74

Abstract

Pigeon fancier’s lung, a form of hypersensitivity pneumonitis (HP), is a rare but important occupational and recreational preventable cause of severe and debilitating breathlessness. We report a case of a 44-year-old Sri Lankan lady presenting with progressive severe breathlessness due to pigeon fancier’s lung. She has bred pigeons for 20 years. She was hypoxemia at rest. There were reticular nodular opacities and diffuse ground glass opacities, inter- and intralobular thickening with subpleural sparing on high resolution imaging. She had marked improvement to glucocorticoid pulses. We diagnosed this patient as subacute on chronic HP considering clinical and radiological evidence. Avoidance of allergen and steroids advised with regular follow up to monitor progression.

Highlights

Hypersensitivity pneumonia (HP), or extrinsic allergic alveolitis, is a spectrum of interstitial, alveolar and bronchiolar lung disease caused by non IgE mediated immunologic reaction occurring within lung parenchyma due to sensitization and subsequent recurrent exposure to various inhaled antigens.This may lead to irreversible damage
It is caused by exposure to air-borne avian antigen which provokes a hypersensitivity reaction in a susceptible host.We report a case of a 44-year-old Sri Lankan lady suffering with severe breathlessness due to pigeon fancier’s lung
With very low procalcitonin levels and radiological evidence of subacute on chronic hypersensitivity pneumonitis she was started on intravenous methylprednisolone 750 mg daily up to three pulses followed by high dose oral prednisolone 1 mg/kg/day maintenance dose

Summary

Introduction

Hypersensitivity pneumonia (HP), or extrinsic allergic alveolitis, is a spectrum of interstitial, alveolar and bronchiolar lung disease caused by non IgE mediated immunologic reaction occurring within lung parenchyma due to sensitization and subsequent recurrent exposure to various inhaled antigens.This may lead to irreversible damage. Pigeon fancier’s lung, a form of hypersensitivity pneumonitis, is an occupational and recreational preventable cause of HP.

Results

Conclusion