Abstract
Bird related hypersensitivity pneumonitis (HP) is becoming more common than other forms of HP around the world. We present two cases of HP, associated with exposure to visiting birds which had nested within their homes in semi urban areas of Colombo, Sri Lanka. A 65-year-old female (case 1) and a 61-year-old male (case 2) presented to the chest clinic complaining of gradually progressive and persistent chronic dry cough and dyspnoea during the year 2018. Both were found to have close contact with red-vented bulbuls (Konda kurulla) in their homes for more than 6 months prior to onset of symptoms and denied any other risk exposures in detail history taking. In both patients, high-resolution computed tomography chest (HRCT) showed centrilobular nodules of ground glass density with significant lobular air trapping. Video-assisted thoracoscopic (VATs) lung biopsy of case 1 showed patchy and focal interstitial thickening with lymphocytic infiltrate, minimal fibrosis, and few noncaseating granulomata within the interstitium. Transbronchial lung biopsy of case 2 showed thickened alveolar septae with lympho-histiocytic infiltrate and occasional neutrophils and eosinopils. Both showed severe reduction in forced vital capacity (FVC) at presentation. Multidisciplinary diagnosis of HP associated with red-vented bulbuls was made. Both achieved good improvement in clinical, lung function, and radiological assessment following removal of offending antigen exposure and treatment with oral corticosteroids.
Highlights
Hypersensitivity pneumonitis (HP) is an immunologically-mediated in ammatory lung disease caused by repetitive inhalation of antigens in a susceptible host [1,2,3]
We report two cases that presented to the Central Chest Clinic, Sri Lanka with a multidisciplinary diagnosis of subacute HP associated with red-vented bulbuls. ere have been no previously published reports of HP associated with red-vented bulbuls or any other visiting birds
Expiratory high-resolution computed tomography chest (HRCT) slices show air trapping in lobules that had decreased attenuation on inspiratory slices with centrilobular nodules of ground glass density (b)
Summary
Hypersensitivity pneumonitis (HP) is an immunologically-mediated in ammatory lung disease caused by repetitive inhalation of antigens in a susceptible host [1,2,3]. Potential causative agents are grouped as microbes, animal proteins, and chemicals [1, 4, 5]. Bird related HP is becoming the commonest form caused by high- and low-molecular-weight proteins found in feathers, faeces, and other animal products commonly of pigeons, parrots, parakeets, love birds, cockatoos, budgerigars, and fowl [4, 6,7,8]. Ere have been no previously published reports of HP associated with red-vented bulbuls or any other visiting birds. We report two cases that presented to the Central Chest Clinic, Sri Lanka with a multidisciplinary diagnosis of subacute HP associated with red-vented bulbuls. This is the rst paper to study this association
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
