• Eric Merrell, Louis Arens, Bishal Gyawali, Michael Nead, and Dominick Roto.
• Department of Pulmonary and Critical Care Medicine. University of Rochester Medicine Center. Rochester, NY. Electronic address: etmerrel@gmail.com.
• Chest. 2024 Oct 1; 166 (4): e113e116e113-e116.

AbstractA 63-year-old woman without significant medical history presented to an urgent care center with a 3-day history of fatigue and dyspnea on exertion. She was found to have an oxygen saturation in the low 80s on room air and was transferred to the closest hospital for further evaluation. Initial chest radiographs showed extensive bilateral interstitial opacities favoring the mid to lower lungs. A general infectious workup was unrevealing. The cause of her symptoms was thought to be an atypical bacterial or viral infection. She was discharged home on supplemental oxygen, 2 L/min via nasal cannula; instructed to finish a 7-day course of antibiotics; and given strict return precautions. Six days later she returned to the ED with worsening dyspnea despite finishing the prescribed course of antibiotics; she was admitted for further evaluation. She had emigrated from Northern India in the early 2000s. While in India, cooking was performed over an open fire. Their home was situated on a poultry farm. She has never smoked. She was up to date on typical cancer screening. She had no pets and denied further exposure to birds since moving to the United States. Her occupational history included manufacturing, but she denied significant exposure to dusts or metal shavings.Copyright © 2024 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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