Chest
Selected ReportsAcute Exacerbations of Fibrotic Hypersensitivity Pneumonitis: A Case Series
Section snippets
Materials and Methods
We retrospectively reviewed the clinical files of patients undergoing consultation, evaluation, or treatment over a 2-year period (January 1, 2005, through January 1, 2007) at the Interstitial Lung Disease Program, National Jewish Medical and Research Center (Denver, CO). The Institutional Review Board approved this retrospective case series.
We sought out subjects with a clinico-radiographic-pathologic (via surgical lung biopsy) diagnosis of fibrotic HP,12, 13 a recent clinical course
Case 1
A 59-year-old woman with a 9-year history of biopsy-proven fibrotic HP secondary to mold exposure in her home environment was admitted to the hospital after 1 to 2 months of increasing dyspnea associated with a nonproductive cough. At the time of the initial diagnosis of fibrotic HP, she had moved out of her home, had the mold abated, and returned back to her home several months prior to the onset of the current symptoms. At the onset of symptoms, she was found to have new ground-glass
Discussion
In this report, we describe four patients with a history of biopsy-proven fibrotic HP who had an acute and accelerated decline in pulmonary status with new bilateral ground-glass opacities on HRCT. Despite an extensive evaluation for infection, cardiac dysfunction, and pulmonary embolism, no etiology for the precipitous deterioration was found. All patients met the recently proposed criteria for an AE-IPF, except these patients had a fibrotic lung disease other than IPF and the unexplained
Acknowledgment
The authors would like to express their gratitude to Carol Bair and Alma Kervitsky for their assistance with data collection.
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2021, Respiratory MedicineCitation Excerpt :The chronic ILDs most frequently reported to be at risk for exacerbations are IPF, chronic HP, and CTD-associated fibrosing ILD. Of note, the acute idiopathic ILDs – cryptogenic organizing pneumonia and acute interstitial pneumonia (or, idiopathic diffuse alveolar damage) – demonstrate two of the three major histopathological manifestations of acute exacerbations of ILD [4–6]. The standard definition and diagnostic criteria for an IPF exacerbation were updated in 2016 by an international workgroup of ILD experts [2,7].
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This work was performed at National Jewish Medical and Research Center, Denver, CO.
The authors have no conflicts of interest to disclose.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).