Service de Pneumologie, Centre Hospitalier Béthune, Lille, France.
Med Mycol. 2012 Aug;50(6):654-7. doi: 10.3109/13693786.2012.658091. Epub 2012 Feb 14.
Hypersensitivity pneumonitis (HP) is a pulmonary granulomatosis involving an immunoallergic mechanism caused by chronic inhalation of antigens, most frequently organic substances, as well as chemicals. We report the first European case of hypersensitivity pneumonitis due to the inhalation of Shiitake mushroom spores. A 37-year-old French Caucasian man with a one-month history of persistent dry cough, shortness of breath and loss of weight was admitted to our hospital on December 2010. Anamnesis showed he was involved in mushroom production beginning in the summer of 2010. His temperature on admission was 36.6°C and he had a normal blood pressure (135/90 mmHg). Bilateral fine crackles were audible in the base of both lungs. Pulmonary function tests showed a mild restrictive pattern with decreased DLco and a PaO(2) of 65 mmHg, Chest CT scan revealed reticulo-nodular shadows, slight ground glass opacities, liner atelectasis, and subpleural opacities in both lung fields. Bronchoscopy was normal but cytological examination of BAL revealed a predominant lymphocytosis (55%). Serum precipitins to the Shiitake mushroom spores were positive (3 precipitins arcs with high intensity) and as a result we advised the patient to cease his mushroom production activities. The diagnosis of hypersensitivity pneumonitis due to inhalation of Shiitake mushroom spores was established as a result of the improvement of all of his clinical symptoms, i.e., cough, weight loss, bilateral fine crackles, mild restrictive pattern of pulmonary function, and reticulo-nodular shadows on chest CT, once exposure was eliminated. Recent interest in exotic mushrooms varieties, e.g., Shiitake, in developed countries because of their possible medicinal properties might increase the potential risk of HP among mushrooms workers. Therefore, healthcare professionals have to take this new potential respiratory disease into account.
过敏性肺炎（HP）是一种肺部肉芽肿性疾病，涉及由慢性吸入抗原引起的免疫过敏机制，最常见的抗原为有机物质和化学物质。我们报告首例因吸入香菇孢子引起的过敏性肺炎的欧洲病例。一名 37 岁的法国白人男子，于 2010 年 12 月因持续干咳、呼吸急促和体重减轻而入院。病史显示，他从 2010 年夏天开始参与蘑菇生产。入院时体温为 36.6°C，血压正常（135/90mmHg）。双肺底部可闻及细湿啰音。肺功能检查显示轻度限制性模式，DLco 降低，PaO2 为 65mmHg。胸部 CT 扫描显示双肺野网状结节影、轻度磨玻璃影、线性肺不张和胸膜下混浊。支气管镜检查正常，但 BAL 的细胞学检查显示以淋巴细胞为主（55%）。血清对香菇孢子的沉淀素呈阳性（3 个沉淀素弧，强度高），因此我们建议患者停止蘑菇生产活动。由于所有临床症状（咳嗽、体重减轻、双肺细湿啰音、肺功能轻度限制性模式以及胸部 CT 上的网状结节影）均得到改善，同时接触被消除，从而确立了因吸入香菇孢子引起的过敏性肺炎的诊断。由于其潜在的药用特性，在发达国家，人们对奇异蘑菇品种（如香菇）的兴趣日益浓厚，这可能会增加蘑菇工人患 HP 的潜在风险。因此，医疗保健专业人员必须考虑到这种新的潜在呼吸道疾病。
