Trichosporon asahii-induced asthma in a family with Japanese summer-type hypersensitivity pneumonitis.
BACKGROUND
Trichosporon species frequently induce summer-type hypersensitivity pneumonitis (SHP), which is the most prevalent type of hypersensitivity pneumonitis (HP) in Japan, but have not been reported to induce asthma.


OBJECTIVE
Evaluation of a case of asthma induced by Trichosporon asahii.


RESULTS
This report describes a 46-year-old Japanese man who developed asthma induced by T. asahii, following symptoms of HP attributable to the same pathogen, in a case of familial occurrence of SHP. This patient lacked typical findings of HP in his radiograph but had an elevated level of eosinophils in his bronchoalveolar lavage fluid. Open lung biopsy, however, revealed typical pathologic findings of HP when he was free of asthmatic symptoms. His serum was also positive for anti-T asahii antibody, as are the sera of SHP patients. Nevertheless, provocation tests, including returning home and inhalations of T. asahii antigen, reproduced asthmatic features such as airway hyperresponsiveness and reversible bronchoobstruction, but not the features of HP. A skin test with the same antigen also evoked an immediate allergic reaction. An IgE mechanism was suspected but could not be proven by radioallergosorbent test. The patient's son and daughter displayed typical features of SHP, associated with compatible results in their radiographs, bronchoalveolar lavage fluid analysis, serologic and pathologic examinations, and provocation and skin tests.


CONCLUSIONS
To our knowledge, this is the first case of extrinsic asthma, and of coexistent asthma and HP, induced by T. asahii. The patient initially displayed symptoms typical of SHP, which were subsequently replaced by more typical asthmatic symptoms.
Hirakata
Yoichi
Y
Department of Pulmonary Medicine, Jichi Medical School, Minamikawachi, Tochigi, Japan. hirakata@net.nagasaki-u.ac.jp
Katoh
Tomoko
T
Ishii
Yoshiki
Y
Kitamura
Satoshi
S
Sugiyama
Yukihiko
Y
D000293:Adolescent; D000328:Adult; D000542:Alveolitis, Extrinsic Allergic / Q000209:etiology* / Q000235:genetics; D000908:Antibodies, Fungal / Q000097:blood; D001249:Asthma / Q000209:etiology* / Q000235:genetics; D005190:Family; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D014250:Trichosporon / Q000276:immunology*
D000908:Antibodies, Fungal