title: Farmer's lung in a case after bullectomy.
abstract: We present a case of farmer's lung (FL) with the primary presenting feature of a large bulla in the lung. A 70-year-old nonsmoking woman with dyspnea on exercise was referred for surgical resection of a large bulla in the lung. The postoperative evaluation of the lung tissue revealed a follicular lymphocytic alveolitis and loosely formed granulomas suspicious for hypersensitivity pneumonitis (HP). The patient had worked in farming since her youth. Dyspnea on exercise was the only symptom, but it was related to the large bulla. No other radiologic features of HP were shown in a high-resolution CT of the lung. Specific IgG antibodies against typical antigens of FL were detected, bronchoalveolar lavage demonstrated no lymphocytic alveolitis but an inhalative challenge with own hay was positive. A diagnosis of chronic FL was made. Despite lung emphysema being a possible reaction in FL, giant bullae as primary and single manifestation of this disease have not been reported before.
authors.affiliation: Department of Pulmonary Diseases, Fachkrankenhaus Coswig, Centre for Pulmonary Diseases and Thoracic Surgery, Coswig, Germany. dr.koschel@fachkrankenhaus-coswig.de
authors.forename: Dirk
authors.initials: D
authors.lastname: Koschel
authors.forename: Jan
authors.initials: J
authors.lastname: Holfert
authors.forename: Axel
authors.initials: A
authors.lastname: Rolle
authors.forename: Olaf
authors.initials: O
authors.lastname: Holotiuk
authors.forename: Gert
authors.initials: G
authors.lastname: Höffken
mesh_terms: D000368:Aged; D000542:Alveolitis, Extrinsic Allergic / Q000276:immunology / Q000473:pathology; D001230:Aspergillus / Q000276:immunology; D001768:Blister / Q000473:pathology / Q000601:surgery*; D004417:Dyspnea; D005203:Farmer's Lung / Q000276:immunology* / Q000473:pathology; D005260:Female; D006099:Granuloma / Q000276:immunology / Q000473:pathology; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D008168:Lung / Q000473:pathology; D016930:Saccharopolyspora / Q000276:immunology
chemical_list: D007074:Immunoglobulin G