Pneumonite de Hipersensibilidade Crónica: evolução de um Caso Clínico

Abstract

INTRODUCTION Hypersensitivity pneumonitis (PH) or extrinsic allergic alveolitis is an inflammatory interstitial lung disease caused by recurrent exposure to a variety of environmental and/ or occupational antigens by immunologically susceptible individuals. The differential diagnosis with other interstitial lung diseases (ILD) is stimulating, but essential for a correct approach and implementation of appropriate therapy. CASE REPORT We present a case of a 55-year-old female worker, non-smoker, with no important pathological personal history. She had professional exposure to multiple paints (Gouache; Acrylics; Watercolors; Oil) inherent in her profession as an art teacher since she was 23 years old. After 24 years of performing these functions, without the use of proper personal protective equipment (protective mask, gloves, goggles, appropriate uniform), she develops a persistent cough, dyspnoea and fatigue, motivating observation in pulmonology consultation. Taking into account clinical, radiological and laboratory elements, she presented suggestive alterations of interstitial pulmonary pathology, and the diagnosis of Chronic Hypersensitivity Pneumonitis was assumed in a Multidisciplinary Group Consultation later assumed and characterized as an Occupational Disease. In the follow-up, the causal agent of the disease was removed, having the worker been mobilized internally, assuming functions associated with school coordination, for which she was able to work. Since 2011 under immunosuppression therapy with Prednisolone, Azathioprine from July 2014 to August 2016 and Mycophenolate Mofetil since March 2019, having remained clinically and functionally stable until today, without the need for oxygen therapy. As complementary diagnostic tests it has a respiratory function in 2019: FEV1 51%; FVC 55%; 73% TLC. 33% DLCO; DLCO/VA: 51%. Chest CT with scattered, bilateral ground glass densification areas; some cystic images, bilaterally, corresponding to areas of bronchial ectasia/ fibrosis; traction bronchiectasis, mainly in the upper lobes and the middle lobe; reticulation areas in the anterior right pulmonary field; calcified granuloma in the lower right lobe and upper left lobe; infracentimetric nodularities at both apexes. DISCUSSION/ CONCLUSION Chronic HP is an irreversible disease. Removal of the disease-causing antigen and immunosuppressive therapy are the usual interventions in these cases. In this worker, once the relationship between the pathology and the causal agent of the disease was assumed, was assigned a definitive incapacity for the current job, having been replaced in another compatible activity within the same company. Thus, occupational health surveillance becomes essential in the prevention/ attenuation of this occupational disease.