title: Bird fanciers' lung induced by exposure to duck and goose feathers.
abstract: METHODS
  Female, 60 FINAL DIAGNOSIS: Bird fanciers' lung Symptoms: Cough productive • hypoxia • short of breath • substernal chest pain
  
  
  METHODS
  - Clinical Procedure: - Specialty: -
  
  
  OBJECTIVE
  Rare disease.
  
  
  BACKGROUND
  Hypersensitivity pneumonitis (HP) is a group of inflammatory interstitial lung diseases caused by hypersensitivity reactions from repeated insults of inhalation of fine particulate organic dusts derived from environmental sources. Bird fanciers' lung (BFL) is the most common form of HP, with an estimated prevalence of 0.5-7.5% and is observed in individuals who develop a hypersensitivity response to avian droppings or antigens on bird feathers.
  
  
  METHODS
  A 60-year-old woman presented to our care with shortness of breath with exertion. She was hypoxic with oxygen saturation of 70% on room air. The CTA of the chest revealed a diffuse bilateral ground glass density in the lung parenchyma with a mosaic attenuation pattern. On further questioning she explained that she collected many duck and goose feathers she found on the ranch and placed them in a vase at home. Transbronchial lung biopsy revealed non-caseating granulomas, aggregates of epithelioid macrophages, and patchy mononuclear cell infiltration with lymphocytes and fibrotic tissue. The patient clinically improved and was discharged home on the 6(th) hospital day with prednisone 20 mg daily, with clinical improvement noted on subsequent follow up visits.
  
  
  CONCLUSIONS
  There is no specific clinical manifestation; abnormal laboratory test results help establish a definitive diagnosis. The best diagnostic tool is the correlation of symptom onset with the environmental exposure. The prognosis is excellent after a single episode of HP, but continuous re-exposure carries the risk of progressive pulmonary impairment.
authors.affiliation: Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, TX, U.S.A.
authors.forename: Chad J
authors.initials: CJ
authors.lastname: Cooper
authors.affiliation: Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, TX, U.S.A.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Teleb
authors.affiliation: Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, TX, U.S.A.
authors.forename: Sherif
authors.initials: S
authors.lastname: Elhanafi
authors.affiliation: Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, TX, U.S.A.
authors.forename: Shajeea
authors.initials: S
authors.lastname: Ajmal
authors.affiliation: Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, TX, U.S.A.
authors.forename: German T
authors.initials: GT
authors.lastname: Hernandez
keywords: Alveolitis; Bird Fancier’s Lung; Bird Feathers; Extrinsic Allergic
references.citation: Eur J Pediatr. 2006 Jan;165(1):55-61
references.pmid: 16270199
references.citation: Allergol Int. 2013 Sep;62(3):389-90
references.pmid: 23880614
references.citation: Eur Respir J. 2008 Aug;32(2):517-21
references.pmid: 18669792
references.citation: BMC Pulm Med. 2006 Jun 26;6:16
references.pmid: 16800875
references.citation: Medicine (Baltimore). 2008 Mar;87(2):110-130
references.pmid: 18344808
references.citation: Int J Prev Med. 2013 May;4(5):599-602
references.pmid: 23930172
references.citation: Thorax. 1992 Nov;47(11):990-1
references.pmid: 1465764
references.citation: Ann Allergy Asthma Immunol. 2003 Jun;90(6):604-10
references.pmid: 12839317
references.citation: Intern Med. 2010;49(23):2605-8
references.pmid: 21139300
references.citation: Eur J Clin Invest. 2010 Sep;40(9):797-802
references.pmid: 20597960
references.citation: Clin Rev Allergy Immunol. 2012 Aug;43(1-2):69-83
references.pmid: 21870048
references.citation: Ann Trop Paediatr. 2004 Dec;24(4):349-55
references.pmid: 15720893
references.citation: Mol Immunol. 2013 Jun;54(2):227-32
references.pmid: 23291145
references.citation: Ann Allergy Asthma Immunol. 2006 Jan;96(1):98-104
references.pmid: 16440540