[Summer-type hypersensitivity pneumonitis in a patient with a positive skin test (15 minutes) for Trichosporon mucoides and a high serum IgE level].
The serum IgE level is usually not high in hypersensitivity pneumonitis (HP) because it develops from Type III and Type IV allergies (Gell and Coombs). However, we have previously reported infiltration of lymphocytes and mast cells in patients with summer-type HP and a high serum IgE level. We encountered a 56-year-old woman with summer-type HP who had a high serum IgE level and a positive skin reaction to the causative antigen. She was admitted to our hospital because of coughing, fever, and dyspnea. On admission, a chest X-ray film and a chest CT scan disclosed ground-glass opacity and diffuse small nodular shadows. Her PaO2 was 56 mmHg on room air and her serum IgE level was high (725 U/ml). Pulmonary-function testing revealed a low DLCo, but the FEV1 was normal. Summer-type HP was diagnosed because of a positive test for serum antibody to Trichosporon mucoides (TIMM1573), a positive result on an antigen challenge test, and because pathological examination of specimens obtained by transbronchial lung biopsy showed severe infiltration of lymphocytes. After admission, her serum IgE levels gradually improved along with the symptoms and the PaO2. A skin test for the causative antigen was done to study the early immunological reaction, and a positive result (22 mm x 24 mm) was obtained for T. mucoides (TIMM1573) in only 15 minutes. We could not elicit any history of atopy that may have been associated with the high serum IgE level and the positive skin test. Therefore, we suspect that this patient had an early immunologic reaction (Type I allergy) to T. mucoides, and that Type I allergy is involved in the development of HP.
Nakajima
M
M
Department of Medicine, Kawasaki Medical School, Kurashiki, Japan.
Manabe
T
T
Niki
Y
Y
Matsushima
T
T
D000542:Alveolitis, Extrinsic Allergic / Q000276:immunology*; D000908:Antibodies, Fungal / Q000032:analysis*; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood*; D008875:Middle Aged; D012621:Seasons; D012882:Skin Tests; D014250:Trichosporon / Q000276:immunology*
D000908:Antibodies, Fungal; D007073:Immunoglobulin E