Pulmonary fibrosis, with sarcoid granulomas and angiitis, associated with handling of mouldy lichen.

We report a case of extrinsic allergic bronchiolo-alveolitis associated with handling of mouldy lichen. The patient had periodic dyspnoea, cough and mucoid sputum, and a micronodular infiltration of both lungs with slight restrictive ventilatory insufficiency. An open lung biopsy showed interstitial inflammation and fibrosis with sarcoid granulomas and angiitis. The symptoms disappeared during long term corticosteroid therapy, but reappeared every year when the patient participated in the handling of lichen (Cladonia alpestris). Precipitating antibodies against Aspergillus fumigatus, A. umbrosus, and Thermoactinomyces vulgaris, were detected in the patient's serum, and against a mixture of fungi including A. terreus, Rhizopus spp., Cladosporium spp., and Penicillium spp., isolated from mouldy lichen storage boxes. After she retired, her symptoms disappeared and the lung function tests showed a slight improvement. In Northern Finland, farmers generally participate in lichen collection. Antigens from mouldy hay and from mouldy lichen may represent a double occupational hazard for them.