• Internal medicine · Feb 2023

    Case Reports

    Fibrotic Hypersensitivity Pneumonitis Diagnosed by a Re-evaluation with Bronchoalveolar Lavage at Disease Deterioration.

    • Mitsuhiro Moda, Toru Arai, Naoko Takeuchi, Tomoko Kagawa, Takayuki Takimoto, Hiromitsu Sumikawa, Shigeki Shimizu, and Yoshikazu Inoue.
    • Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan.
    • Intern. Med. 2023 Feb 15; 62 (4): 577582577-582.

    AbstractA 79-year-old man was admitted with worsening cough, dyspnea, and increased ground-glass opacity on chest computed tomography (CT). He had been diagnosed with idiopathic pulmonary fibrosis given the absence of an identifiable cause of interstitial pneumonia, chest CT findings, and absence of lymphocytosis in bronchoalveolar lavage (BAL) fluid. Meticulous history taking revealed extensive exposure to inciting antigens contained in chicken fertilizer before symptom worsening. A re-evaluation with BAL showed lymphocytosis, and clinical improvement with antigen avoidance confirmed the diagnosis of fibrotic hypersensitivity pneumonitis (fHP). A re-evaluation with BAL at disease deterioration after possible exposure to inciting antigen can facilitate a correct fHP diagnosis.

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