Dr. Duggan presented a case of "bird fancier's lung" which is a hypersensitvity pneumonitis. Common symptoms include: weight loss, fever, shortness of breath, dry cough, chest discomfort, anorexia, chills and extreme fatigue.
It is diagnosed if there are 3 or more of the following:
- known exposure
- compatible exam, imaging and/or PFT findings
- BAL with lymphocytosis
- positive inhalation test
- hisopathology demonstrating noncaseating granulomas
Once the diagnosis is made the treatement is: antigen removal and then more antigen removal and then maybe some steroids. Of note, steroids do not seem to alter long-term prognosis after review of a 1992 randomized, double-blind, placebo-controlled trial of 36 indviduals with Farmer's Lung published in the American Review of Respiratory Disease. Thus, steroids may be an adjunct to antigen removal if there are persistent symptoms or hypoxia. Additionally, this case is a reminder to ask about exposures- if we don't ask, we don't know!