Prasad Rohan Madhu, Kemnic Tyler, Al-Abcha Abdullah, Sharma Akhil, Kavuturu Shilpa
Department of Internal Medicine, Michigan State University-Sparrow Hospital, Lansing, MI.
Ochsner J. 2021 Winter;21(4):425-430. doi: 10.31486/toj.20.0163.
Hypersensitivity pneumonitis, also known as extrinsic allergic alveolitis, is a pulmonary disease with large knowledge gaps, including etiology, pathogenesis, diagnosis, and treatment. A 58-year-old male with a pertinent history of recurrent presented to a tertiary emergency department after 1 week of difficulty breathing. He also reported a productive cough and fevers. The patient was an active smoker and was recently exposed to chemical fire-retardant spray. Chest x-ray showed extensive bilateral pulmonary infiltrates. The tertiary center initiated cefpodoxime 200 mg twice daily for 5 days and home azithromycin for possible pneumonia. However, the patient returned the next day with worsening symptoms. After the patient transferred to our institution, physical examination revealed a hypoxic patient with bibasilar crackles and wheezes. Laboratory tests revealed elevated white blood cell count, sedimentation rate, and immunoglobulin E. Chest computed tomography demonstrated growth of a previously noted right upper lobe intracavitary lesion and new onset diffuse interstitial pulmonary ground-glass airspace opacities. Hypersensitivity pneumonitis panel demonstrated positive antibodies to antibody precipitin 1 and . The patient was given oral prednisone and advice on proper respiratory precautions in the workplace. This case illustrates that hypersensitivity pneumonitis can develop via chemical fire-retardant spray. Additionally, patients with a smoking history and elevated immunoglobulin E should be evaluated for severe forms of the disease.
过敏性肺炎，又称外源性过敏性肺泡炎，是一种在病因、发病机制、诊断和治疗等方面存在诸多知识空白的肺部疾病。一名58岁男性，有反复发病的相关病史，在出现呼吸困难1周后前往三级急诊科就诊。他还伴有咳痰和发热症状。该患者为现吸烟者，近期接触过化学阻燃喷雾剂。胸部X线显示双侧肺部广泛浸润。三级中心开始给予头孢泊肟200毫克，每日两次，共5天，并给予阿奇霉素居家服用，以治疗可能的肺炎。然而，患者次日症状加重后返回。患者转至我院后，体格检查发现患者缺氧，双肺底部有湿啰音和哮鸣音。实验室检查显示白细胞计数、血沉和免疫球蛋白E升高。胸部计算机断层扫描显示先前发现的右上叶腔内病变增大，且出现新的弥漫性间质性肺磨玻璃样空气间隙混浊。过敏性肺炎检测显示针对抗体沉淀素1和 的抗体呈阳性。患者接受了口服泼尼松治疗，并得到了关于工作场所适当呼吸防护措施的建议。 本病例表明，过敏性肺炎可通过接触化学阻燃喷雾剂而发病。此外，有吸烟史且免疫球蛋白E升高的患者应评估是否患有严重形式的该疾病。
