Extrinsic allergic alveolitis induced by spores of Penicillium in a salami factory worker

We report a case of subacute extrinsic allergic alveolitis due to occupational exposure to Penicillium spores in a 43-years old female working in a salami factory that developed a dry cough that gradually evolved to productive cough, shortness of breath, fatigue and body weight loss. Over time she complained of several episodes of flu-like symptoms that worsen around the periods in which she removed the excess mould from the surface of the salami a work. On admission, physical examination revealed crackles in both lungs on chest auscultation, pulmonary function tests showed a restrictive pattern with reduced diffusion capacity of carbon monoxide and imagistic tests identified centrilobular nodules of ground-glass opacity in both lung fields, particularly in the upper lobes. BAL showed lymphocytosis associated with neutrophilia, a pattern consistent with EAA. She was put on systemic corticosteroids and ceased exposure. The patient was compliant and after one year her medication was gradually withdrawn and in the absence of exposure, symptoms and pulmonary function normalized. The reported case had a favorable outcome due to relatively early detection and absence of exposure. Currently, the identification and removal of the causative agent remains the cornerstone of prevention, evolution and prognosis.