title: Hypersensitivity pneumonitis induced by spores of Lyophyllum aggregatum.
abstract: OBJECTIVE
  Lyophyllum aggregatum (LA) is called Shimeji in Japanese and is eaten commonly as a mushroom. Shimeji mushrooms are cultivated in an indoor environment all year round. This study aimed to clarify the clinical features of hypersensitivity pneumonitis (HP) induced by LA.
  
  
  METHODS
  Ten patients showed mild respiratory symptoms including dry cough, sputum, and low-grade fever. We tried to characterize the clinical features and the findings using chest high-resolution CT (HRCT), pulmonary function tests (PFTs), and BAL fluid (BALF) tests in patients with HP induced by LA. HP was diagnosed from clinical features, HRCT findings, BALF findings, lung histology, and lymphocyte stimulation tests (LSTs) for LA.
  
  
  RESULTS
  Laboratory findings showed mean (+/- SD) elevated levels of C-reactive protein (0.78 +/- 1.3 mg/dL), erythrocyte sedimentation rate (48 +/- 23 mm/h), and gamma-globulin (26.9 +/- 7.6%). PFTs revealed a slight decrease in the percentage diffusing capacity of the lung for carbon monoxide, possibly due to the presence of epithelial granulomas in the alveoli. Although 4 of 10 patients showed normal findings on the chest radiograph (CXR), chest HRCT findings of all patients showed centrilobular small nodules and diffuse ground-glass opacities. The BALF testing revealed an increase in total cell counts, showing predominantly activated T lymphocytes. The CD4/CD8 cell ratio was significantly decreased (0.5 +/- 0.3). The results of the LSTs were positive in seven of seven cases.
  
  
  CONCLUSIONS
  Since patients with HP induced by LA typically have mild respiratory symptoms and sometimes normal CXR findings, their conditions might remain undiagnosed. However, the chest HRCT images showed the typical subacute phase of HP.
authors.affiliation: First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Tsushima
authors.forename: K
authors.initials: K
authors.lastname: Fujimoto
authors.forename: Y
authors.initials: Y
authors.lastname: Yamazaki
authors.forename: A
authors.initials: A
authors.lastname: Takamizawa
authors.forename: T
authors.initials: T
authors.lastname: Amari
authors.forename: T
authors.initials: T
authors.lastname: Koizumi
authors.forename: K
authors.initials: K
authors.lastname: Kubo
mesh_terms: D000328:Adult; D000363:Agaricales; D000368:Aged; D016902:Air Pollution, Indoor / Q000009:adverse effects*; D000542:Alveolitis, Extrinsic Allergic / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D001706:Biopsy; D001992:Bronchoalveolar Lavage Fluid; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007564:Japan; D008168:Lung / Q000473:pathology; D008176:Lung Volume Measurements; D008297:Male; D008875:Middle Aged; D013172:Spores, Fungal; D014057:Tomography, X-Ray Computed