Alveolitis in an Asymptomatic Pigeon Breeder

Abstract

To the Editor:Recently Costabel et al (Chest 1984; 85:514–18) studied T-lymphocytosis in bronchoalveolar lavage (BAL) fluid of patients with hypersensitivity pneumonitis (HP). This study revealed that lymphocytosis in BAL of HP is predominated by suppressor T-lymphocytes.We studied BAL and peripheral blood of a pigeon breeder who had contact with pigeons for 18 years, without clinical symptoms of pigeon breeder's lung. Total IgE in peripheral blood was 60 IU/ml (normal). Circulating serum precipitins to pigeon antigens were demonstrated. Pulmonary function tests and diffusing capacity (Dco) were normal. Bronchomucosal biopsies showed chronic inflammation with infiltration of predominantly plasma cells and lymphocytes. We applied fluorescein isothiocyanate (FITC) labelled monoclonal antibodies to study T-lymphocyte subsets in BAL and peripheral blood. Analysis of BAL fluid demonstrated 30 percent lymphocytes, 65 percent macrophages and 5 percent granulocytes. Immunologic characterization revealed that the BAL lymphocytes were T-lymphocytes with a helper/suppressor (H/S) ratio of 0.7. This H/S ratio is depressed as compared to patients with sarcoidosis and T-lymphocytosis in BAL. About 60 percent of the mononuclear cells in the peripheral blood were lymphocytes with a H/S ratio of 1.8, which is in the normal range. Although this patient had no clinical symptoms of pigeon breeder's lung, our results demonstrated that an alveolitis was present.Previous observations by others1Solal-Celigny Ph Lavioletto M. Hébert J. Cornier Y. Immune reactions in the lungs of asymptomatic dairy farmers.Am Rev Respir Dis. 1982; 126: 964-967PubMed Google Scholar, 2Leatherman J.W. Micheal A.F. Kronenberg R.S. Schwartz B.S. Hoidal J.R. Evaluation of cell-mediated immunity (CMI) in the lung by monoclonal antibodies in hypersensitivity pneumonitis (HP) and asymptomatic pigeon breeders (APB).Am Rev Respir Dis. 1983; 127 (suppl): 62Google Scholar, 3Moritz E.D. Smiejan J.M. Keogh B.A. Crystal R.G. Non-fibrotic pigeon breeders syndrome: A disorder characterized by a chronic suppressor T-cell alveolitis.Clin Res. 1982; 30: 435Google Scholar showed that in patients with antigen exposure but without clinical evidence of HP and without radiologic or lung function abnormalities, alveolitis can exist. Costabel et al clearly demonstrated that after cessation of antigen exposure signs of an alveolitis were still present in BAL fluid, even in otherwise normal patients in whom hypersensitivity pneumonitis alveolitis could be demonstrated. Our findings demonstrate alveolitis in an asymptomatic pigeon breeder. Patients with pigeon breeder's lung and asymptomatic pigeon breeders both can demonstrate T-lymphocytosis with a depressed H/S ratio in BAL fluid. To the Editor: Recently Costabel et al (Chest 1984; 85:514–18) studied T-lymphocytosis in bronchoalveolar lavage (BAL) fluid of patients with hypersensitivity pneumonitis (HP). This study revealed that lymphocytosis in BAL of HP is predominated by suppressor T-lymphocytes. We studied BAL and peripheral blood of a pigeon breeder who had contact with pigeons for 18 years, without clinical symptoms of pigeon breeder's lung. Total IgE in peripheral blood was 60 IU/ml (normal). Circulating serum precipitins to pigeon antigens were demonstrated. Pulmonary function tests and diffusing capacity (Dco) were normal. Bronchomucosal biopsies showed chronic inflammation with infiltration of predominantly plasma cells and lymphocytes. We applied fluorescein isothiocyanate (FITC) labelled monoclonal antibodies to study T-lymphocyte subsets in BAL and peripheral blood. Analysis of BAL fluid demonstrated 30 percent lymphocytes, 65 percent macrophages and 5 percent granulocytes. Immunologic characterization revealed that the BAL lymphocytes were T-lymphocytes with a helper/suppressor (H/S) ratio of 0.7. This H/S ratio is depressed as compared to patients with sarcoidosis and T-lymphocytosis in BAL. About 60 percent of the mononuclear cells in the peripheral blood were lymphocytes with a H/S ratio of 1.8, which is in the normal range. Although this patient had no clinical symptoms of pigeon breeder's lung, our results demonstrated that an alveolitis was present. Previous observations by others1Solal-Celigny Ph Lavioletto M. Hébert J. Cornier Y. Immune reactions in the lungs of asymptomatic dairy farmers.Am Rev Respir Dis. 1982; 126: 964-967PubMed Google Scholar, 2Leatherman J.W. Micheal A.F. Kronenberg R.S. Schwartz B.S. Hoidal J.R. Evaluation of cell-mediated immunity (CMI) in the lung by monoclonal antibodies in hypersensitivity pneumonitis (HP) and asymptomatic pigeon breeders (APB).Am Rev Respir Dis. 1983; 127 (suppl): 62Google Scholar, 3Moritz E.D. Smiejan J.M. Keogh B.A. Crystal R.G. Non-fibrotic pigeon breeders syndrome: A disorder characterized by a chronic suppressor T-cell alveolitis.Clin Res. 1982; 30: 435Google Scholar showed that in patients with antigen exposure but without clinical evidence of HP and without radiologic or lung function abnormalities, alveolitis can exist. Costabel et al clearly demonstrated that after cessation of antigen exposure signs of an alveolitis were still present in BAL fluid, even in otherwise normal patients in whom hypersensitivity pneumonitis alveolitis could be demonstrated. Our findings demonstrate alveolitis in an asymptomatic pigeon breeder. Patients with pigeon breeder's lung and asymptomatic pigeon breeders both can demonstrate T-lymphocytosis with a depressed H/S ratio in BAL fluid.