Article

A case with chronic bird fancier's lung presenting boop X-ray image and fibrotic NSIP histological pattern

Authors:
  • Yokosuka Kyosai Hospital, Japan, Yokosuka
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Abstract

A 65-year-old female was admitted to the hospital because of exertional dyspnea. She had been raising indoors one parakeet for the consecutive twenty years until one year prior to the admission and two pigeons for the last two years before the admission. A Chest CT and open lung bipsy specimens showed BOOP CT images and fibrotic non-specific interstitial pneumonitis (NSIP) histological pattern respectively. She was diagnosed as having bird fancier's lung (BFL) because of the elevated IgG1 and IgA1 antibodies against pigeon dropping extracts in the serum and BALF. Administration of prednisolone resulted in the clinical improvement, resolution of BOOP histological pattern, and residual reticular shadows and honeycombing on chest CT. She stopped raising birds and she has been free of any symptoms after discontinuation of prednisolone. It was concluded that she had had chronic BFL with fibrosis due to small amounts of antigen exposure (a parakeet) complicated with an acute episode induced by the considerable amounts of antigen exposure (two pigeons). We should recognized that radiological and pathological BOOP as well as NSIP pattern is one of the lung manifestations of the BFL.

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Article
Hypersensitivity pneumonitis (HP) secondary to bird exposure is treated with glucocorticosteroids and avoidance. Despite therapy, symptoms may persist for a prolonged time. Just as cat antigen, Fel d 1, may persist for greater than 20 weeks after cat removal, there may be persistent bird antigen to explain prolonged symptoms in bird HP. It was the intent of this study to determine household distribution and persistence of bird antigen after removal of the bird from the patient's home. The homes of patients with birds were followed serially after bird removal with multiple samples collected using a hand-held vacuum cleaner. Bird antigen levels were determined by an inhibition enzyme-linked immunoassay. In five homes the antigen declined gradually despite extensive environmental control measures, with high levels still detectable at 18 months in one home. This data suggests that high levels of bird antigen can be detected for prolonged periods of time after bird removal and environmental cleanup. The antigen may account for the persistence of disease in some patients with HP. In severe HP, the preferred therapy may be temporary relocation of the patient away from the room in which the bird was housed, in addition to corticosteroids, until the patient's environment is demonstrated to be relatively bird antigen-free.