Department of Respiratory Medicine, Mater Dei Hospital, L-Imsida, Malta
Department of Respiratory Medicine, Mater Dei Hospital, L-Imsida, Malta.
BMJ Case Rep. 2020 Dec 22;13(12):e237232. doi: 10.1136/bcr-2020-237232.
A 62-year-old woman presented with a 3-month history of shortness of breath on exertion and dry cough. On examination, she was noted to have fine end-inspiratory crepitations over the upper zone of the lungs. Pulmonary function tests (PFTs) showed a restrictive defect. Initial chest radiography revealed diffuse reticular interstitial shadowing while high-resolution CT scan of the thorax showed fibrotic changes. Avian precipitins were also highly positive for pigeons, parrots and budgerigars. Taking into account these results, the patient was diagnosed with hypersensitivity pneumonitis. Antigen avoidance, oral glucocorticoids and azathioprine achieved an initial improvement in PFTs and symptoms; however, the patient still deteriorated, requiring long-term oxygen therapy. While working the patient up for lung transplantation, rituximab was given to good effect (acting as a bridging therapy) as it achieved symptomatic relief and stabilisation of her PFTs.
一位 62 岁女性因劳力性呼吸困难和干咳 3 个月就诊。体格检查发现双肺上区吸气末细湿啰音。肺功能检查（PFTs）显示限制性缺陷。初始胸部 X 线检查显示弥漫性网状间质性阴影，而胸部高分辨率 CT 扫描显示纤维化改变。禽沉淀素对鸽子、鹦鹉和虎皮鹦鹉也呈高度阳性。鉴于这些结果，患者被诊断为过敏性肺炎。抗原回避、口服糖皮质激素和硫唑嘌呤最初改善了 PFTs 和症状；然而，患者仍在恶化，需要长期氧疗。在为患者进行肺移植评估时，给予利妥昔单抗治疗效果良好（作为桥接治疗），因为它缓解了症状并稳定了她的 PFTs。
