To the Editor:
It is well known that exposure to isocyanate can lead to the development of asthma and is recognised as one of the major aetiologies of occupational asthma [1]. In contrast, hypersensitivity pneumonitis (HP) due to isocyanates is a rare condition.
In July 2009, a 42-yr-old female was admitted to our respiratory intensive care unit (Respiratory Dept, Centre Hospitalier Universitaire du Bocage, Dijon, France) for progressive, but severe, respiratory distress. She had no particular medical history but was a heavy smoker with a habit of 30 cigarettes a day since the age of 15 yrs. Symptoms had started 6 months earlier, with very progressive shortness of breath on exertion and dry cough. This was followed by frequent bouts of fever reaching 39°C, chills, headaches and arthralgia without swelling. Symptoms transiently improved when she received oral corticosteroids for 7 days a month before admission. A chest radiograph performed 2 months earlier was considered normal. On admission, she was hypoxaemic, with transcutaneous saturation measured at 85%, partially corrected by oxygen (10 L·min−1). Her central temperature was 39°C. Auscultation revealed wheezing, crackles and ronchi. The laboratory examinations showed that the erythrocyte sedimentation rate (68 mm·h−1), C-reactive protein (138 mg·L−1), fibrinogen (6.4 g·L−1) and serum lactate dehydrogenase (544 IU·L−1) were all high. The white blood cell count was elevated (total: 11.5×103 cells·mm−3; neutrophils: 9.2×103 cells·mm−3 …