title: Hypersensitivity pneumonitis due to flavocoxid: are corticosteroids necessary?
abstract: BACKGROUND
  Hypersensitivity pneumonitis (HP) is a rare adverse event with flavocoxid (Limbrel) use. Patients present with nonspecific symptoms after exposure to an inciting agent.
  
  
  METHODS
  A 42-year-old female presented with worsening dyspnea on exertion and pleuritic midsternal chest pain. Her symptoms failed to abate with outpatient azithromycin for a diagnosis of community-acquired pneumonia. She was seen again at the emergency department (ED) due to symptom progression and exertional hypoxia. Chest reoentgenogram (x-ray) and computed tomography (CT) chest revealed bilateral infiltrates. Her history was significant for initiation of flavocoxid (Limbrel) two weeks prior, and a diagnosis of hypersensitivity pneumonitis was made. Once flavocoxid was discontinued, symptoms and radiologic studies improved without requiring biopsy or steroids.
  
  
  CONCLUSIONS
  Hypersensitivity pneumonitis is associated with many pharmacological agents and is challenging to diagnose, given nonspecific symptoms and radiologic findings. In the absence of specific indications to use corticosteroids, symptoms of HP might resolve with cessation of the offending agent, as proven by this case.
authors.affiliation: University of Connecticut Internal Medicine Residency Program, University of Connecticut Health Center, 263 Farmington Ave., Farmington, CT 06030, USA. VPanduranga@resident.uchc.edu
authors.forename: Veena
authors.initials: V
authors.lastname: Panduranga
authors.forename: Jonessa
authors.initials: J
authors.lastname: Atienza
authors.forename: Anupam
authors.initials: A
authors.lastname: Kumar
authors.forename: Mark L
authors.initials: ML
authors.lastname: Metersky
mesh_terms: D000305:Adrenal Cortex Hormones / Q000494:pharmacology*; D000328:Adult; D000542:Alveolitis, Extrinsic Allergic / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D001706:Biopsy; D002392:Catechin / Q000009:adverse effects* / Q000627:therapeutic use; D003937:Diagnosis, Differential; D004338:Drug Combinations; D005260:Female; D006801:Humans; D010003:Osteoarthritis / Q000188:drug therapy; D014057:Tomography, X-Ray Computed
chemical_list: D000305:Adrenal Cortex Hormones; D004338:Drug Combinations; C544478:flavocoxid; D002392:Catechin