Abstract
A sudden onset of malaise, weakness and dyspnea on exertion are the striking signs in the case history of 4 women. Objective findings include a restrictive ventilation pattern and a marked hypoxemia on exertion. Radiographic findings suggest ground glass-like attenuations and acinar/interstitial infiltrates (with tree in bud phenomena) in cases 1, 2 and 4, whereas case 3 does not show these characteristics. The history in regard to allergic events is at first uneventful in cases 1 - 3, only case 4 presents with the clinical suspicion of extrinsic allergic alveolitis. BAL cytology shows marked lymphocytosis in all cases, the CD4/CD8 ratio is lowered in 3 ofthe 4 patients. Serologic studies are conclusive first only in case 4. In cases 1 - 2, additional tests display also marked IgG antibodies against goose and duck feathers. Diagnosis is ascertained by repeated histories with more details on living and working habits, especially when using feather beddings. Avoiding the feathers results in a complete remission of the symptoms in all cases.
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