title: [Hypersensitivity pneumonitis induced by Hypsizigus marumoreus].
abstract: We present the case of a 53-year-old woman who was employed at a mushroom (Pleurotus eryngii and Hypsizigus marumoreus) cultivation factory for 15 years. She was admitted to our hospital because of fever and dry cough. Chest radiography and CT scanning revealed diffuse ground glass opacity and centrilobular nodules in both lung fields. Serum KL-6 was elevated. In the bronchoalveolar lavage fluid, the CD4/CD8 ratio was reduced, and the lymphocyte fraction was very high. Transbronchial lung biopsy specimens showed lymphocyte alveolitis. After admission, the patient's symptoms improved rapidly without medication. Although these findings are compatible with hypersensitivity pneumonitis, it was difficult to identify a causative antigen. Serum antibody against Trichosporon was positive. A lymphocyte stimulation test of the peripheral blood was positive against extracts of P. eryngii and H. marumoreus. Furthermore, precipitins against the extracts of H. marumoreus were detected by a double immunodiffusion test. Therefore, we decided to conduct a challenge test using H. marumoreus. As an inhalation provocation test with H. marumoreus conducted in a sickroom caused the same clinical symptoms and signs as experienced in the workplace, we diagnosed hypersensitivity pneumonitis caused by H. marumoreus. A provocation test, in which antigen exposure is limited using a closed space, such as a sickroom, was simple, safe and effective for determining the antigen causing hypersensitivity pneumonitis.
authors.affiliation: Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center.
authors.forename: Yotaro
authors.initials: Y
authors.lastname: Takaku
authors.forename: Noboru
authors.initials: N
authors.lastname: Takayanagi
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Minagawa
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Tsuchiya
authors.forename: Naoya
authors.initials: N
authors.lastname: Hijikata
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Hara
authors.forename: Tomohisa
authors.initials: T
authors.lastname: Yamaji
authors.forename: Daido
authors.initials: D
authors.lastname: Tokunaga
authors.forename: Hiroo
authors.initials: H
authors.lastname: Saito
authors.forename: Mikio
authors.initials: M
authors.lastname: Ubukata
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Kurashima
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Yanagisawa
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Sugita
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Kawabata
mesh_terms: D000363:Agaricales / Q000276:immunology*; D000382:Agricultural Workers' Diseases / Q000209:etiology / Q000276:immunology; D000542:Alveolitis, Extrinsic Allergic / Q000209:etiology* / Q000276:immunology; D001985:Bronchial Provocation Tests; D005260:Female; D006801:Humans; D008875:Middle Aged