Hypersensitivity pneumonitis (HP) is an interstitial lung disease (ILD), consequence of an alveolar allergic reaction against various inhaled allergens occurring in susceptible individuals, manifesting as an acute or chronic granulomatous alveolar allergic process against inflammation of the lung parenchyma. The clinical presentation can mimic acute respiratory infections (in acute form) or an idiopathic ILD (in chronic form); the diagnosis of HP is difficult if the exposure to allergen is not suspected.
We present the case of a male teenager, pigeon breeder, presenting with recurrent episodes of dyspnoea and fever, initially considered and treated as pneumonia. The diagnosis of HP was based on suggestive imaging changes, lymphocytic alveolitis at bronchoalveolar lavage with a low CD4/CD8 ratio and a thorough anamnesis for exposure and positive IgG serum precipitins against pigeon debris. The patient improved over a few months only by avoiding exposure to the incriminated allergen. ILDs in children and adolescents are considered rare diseases, with HP being one of the possible causes in older children and adolescents.
Teodor Salmen, Daniel Traila and Irina Ruxandra Strambu
Introduction. Registries are necessary particularly for rare diseases. The REGIS registry was developed to improve scientific research in the field of interstitial lung diseases (ILDs).
Material and Method. We analysed 144 patients with interstitial lung diseases enrolled during a three year period, selected the sarcoidosis cases and analysed the data with Excel 2007 Software.
Results. A number of 26 sarcoidosis patients were included (18.06% out of the total), of which 46.15% were female, with an average age of 41.34±9.84 years; 23.08% were smokers. 88.46% pf patients had mediastinum pulmonary involvement: stage II in 17 patients, stage III in 5 patients and stage IV in one patient; only 3 patients had extra thoracic involvement. The medical investigations performed were: chest X-ray (96.15%), thoracic HRCT (96.15%) that identified hilar adenopathy (96%), nodules (68%), with peribronchovascular localization (44%); spirometry (96.15%) that revealed an average CV of 94.99±23.07% out of the predicted value, DLCO 78.41±19.39% out of the predicted value; bronchoalveolar lavage (38.46%); serum angiotensin-converting enzyme (73.08%) and pulmonary or lymph node biopsy (80.77%). The patients that needed treatment (46.15%) were administered oral corticosteroids (10 patients), acetylcysteine (1 patient) and pirfenidone (1 patient).
Conclusions. The number of patients enrolled is low as a result of the voluntary reporting, especially in severe cases and with access to all investigations needed for diagnosing.