title: Occupational hypersensitivity pneumonitis in a green tea manufacturer.
abstract: Hypersensitivity pneumonitis (HP) is caused by numerous agents, and one of its histopathological features is poorly formed granulomas. We report here a rare case of occupational HP caused by green tea, showing well-formed granulomas. The patient, a 54-year-old woman who had worked for 15 years in a green tea factory, was referred for abnormal chest X-ray shadows with cough and breathlessness over a 2-month period. The chest X-ray and high-resolution computed tomography showed diffuse bilateral ground-glass opacities and poorly defined centrilobular nodules. Histopathological examination of the thoracoscopic lung biopsy specimens showed bronchiolocentric interstitial pneumonia with well-formed granulomas. Although the form of granulomas were atypical, laboratory data, CT findings, and intradermal skin testing suggested the diagnosis of subacute HP caused by green tea. After transfer to a different department, her condition improved markedly. Taking a precise medical history and avoidance of the suspected environmental agent proved useful in diagnosing this condition. © 2016 The Authors. Respirology Case Reports published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology.
authors.affiliation: Department of Respiratory Medicine Shizuoka General Hospital Shizuoka Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Tanaka
authors.affiliation: Department of Respiratory Medicine Shizuoka General Hospital Shizuoka Japan.
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Shirai
authors.affiliation: Second Department of Internal Medicine Hamamatsu University School of Medicine Hamamatsu Japan.
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Enomoto
authors.affiliation: Department of Respiratory Medicine Shizuoka General Hospital Shizuoka Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Asada
authors.affiliation: Second Department of Internal Medicine Hamamatsu University School of Medicine Hamamatsu Japan.
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Oyama
authors.affiliation: Second Department of Internal Medicine Hamamatsu University School of Medicine Hamamatsu Japan.
authors.forename: Takafumi
authors.initials: T
authors.lastname: Suda
keywords: Granuloma; green tea; hypersensitivity pneumonitis; occupation