Abd El-Kareem Dalia, Akl Yosri M, Nakhla Gina A, Elhindawi Ali A, Eltorky Mahmoud A
Department of Pathology, Faculty of Medicine - Kasr Al-Ainy, Cairo University, Cairo, 11562 Egypt.
Department of Pulmonary Medicine, Faculty of Medicine - Kasr Al-Ainy, Cairo University, Cairo, 11562 Egypt.
Multidiscip Respir Med. 2017 May 8;12:10. doi: 10.1186/s40248-017-0091-6. eCollection 2017.
Hypersensitivity pneumonitis (HP) is a common diffuse parenchymal lung disease in Egypt which can be difficult to recognize due to the dynamic symptoms & associated environmental factors.
Forty-three Egyptian patients were enrolled in this study, presenting with dyspnea and cough, predominant ground-glass opacity (GGO) in high-resolution computed tomography (HRCT) where lung biopsy was needed to establish the diagnosis.
The age range was 15 to 60 years. Females represented 90.7% (39 patients) while 9.3% (4 patients) of our patients were males. History of contact with birds was detected in 9 (20.9%) patients. Most of our patients (60.5%) didn't have exposure history, and only 8 patients (18.6%) were living in geographic areas in Egypt that are known for the exposure to environmental etiologic factors (cane sugar exhaust fumes). The most common HRCT pattern was GGO with mosaic parenchyma in 18 patients (41.86%), followed by GGO with centrilobular nodules in 9 patients (20.93%), then isolated diffuse GGO in 5 patients (11.62%), GGO with traction bronchiectasis in 4 patients (9.3%), GGO with consolidation in 3 patients (6.97%), GGO with reticulations in 2 patients (4.65%), and GGO with cysts in 2 patients (4.65%). The most common histologic finding was isolated multinucleated giant cells in 38 patients (88.3%) commonly found in airspaces (24 patients) and less commonly in the interstitium (14 patients), followed by interstitial pneumonia and cellular bronchiolitis in 36 patients (83.7% each), interstitial ill-formed non-necrotizing granulomas in 12 patients (27.9%), fibrosis in 10 patients (23.2%), and organizing pneumonia pattern in 4 patients (9.3%).
The diagnosis of HP presenting with predominant GGO pattern in HRCT requires a close interaction among clinicians, radiologists, and pathologists. Some environmental and household factors may be underestimated as etiologic factors. Further environmental and genetic studies are needed especially in patients with negative exposure history.
过敏性肺炎（HP）在埃及是一种常见的弥漫性实质性肺疾病，由于其症状动态变化及相关环境因素，可能难以识别。
本研究纳入了43例埃及患者，这些患者表现为呼吸困难和咳嗽，高分辨率计算机断层扫描（HRCT）主要表现为磨玻璃影（GGO），需要进行肺活检以明确诊断。
年龄范围为15至60岁。女性占90.7%（39例），男性占9.3%（4例）。9例（20.9%）患者有接触鸟类史。大多数患者（60.5%）无暴露史，仅8例（18.6%）患者生活在埃及已知存在环境致病因素（蔗糖废气）暴露的地区。最常见的HRCT表现为18例（41.86%）GGO伴马赛克样实质，其次是9例（20.93%）GGO伴小叶中心结节，然后是5例（11.62%）孤立性弥漫性GGO，4例（9.3%）GGO伴牵拉性支气管扩张，3例（6.97%）GGO伴实变，2例（4.65%）GGO伴网状改变，2例（4.65%）GGO伴囊肿。最常见的组织学表现为38例（88.3%）孤立性多核巨细胞，常见于肺泡腔（24例），较少见于间质（14例），其次是36例（各83.7%）间质性肺炎和细胞性细支气管炎，12例（27.9%）间质内形态不规则的非坏死性肉芽肿，10例（23.2%）纤维化，4例（9.3%）机化性肺炎样表现。
HRCT主要表现为GGO型的HP诊断需要临床医生、放射科医生和病理科医生密切协作。一些环境和家庭因素作为致病因素可能被低估。尤其对于无暴露史的患者，需要进一步开展环境和遗传学研究。
