Show simple item record

dc.contributor.authorHolden, V.K.
dc.contributor.authorKligerman, S.J.
dc.contributor.authorHastings, T.G.
dc.date.accessioned2019-10-08T19:43:53Z
dc.date.available2019-10-08T19:43:53Z
dc.date.issued2017
dc.identifier.urihttps://www.scopus.com/inward/record.uri?eid=2-s2.0-85021049463&doi=10.1093%2foccmed%2fkqx030&partnerID=40&md5=e004d6c94c96724e11eb1f0f6263d3fa
dc.identifier.urihttp://hdl.handle.net/10713/11131
dc.description.abstractBackground This case highlights the importance of considering hypersensitivity pneumonitis (HP) in the differential diagnosis of interstitial lung disease (ILD) and of obtaining an occupational history so that remediable risk factors may be identified and managed. Aims To report a case of a chicken sexer with severe rheumatoid arthritis (RA) who developed progressively worsening dyspnoea and restrictive lung disease associated with pulmonary fibrosis. Methods Clinical investigation included physical examination, occupational history, pulmonary function tests (PFTs), chest imaging and bronchoalveolar lavage (BAL), as well as serological tests including standard IgE bird feather mixture and local IgG precipitin preparation to chicken excrement. Lung histopathology was examined post-mortem. Results The patient had worked as a chicken sexer for 29 years with limited control of exposure to chicken bioaerosols. PFTs initially showed mild restriction with a moderate gas transfer defect and computerized tomography of the chest exhibited extensive interstitial infiltrates throughout with severe honeycombing at the bases. Cytology from a BAL revealed multinucleated giant cells (MNGs). Specific serologic tests for bird antigens were negative. Histopathology demonstrated diffuse interstitial fibrosis with honeycombing, poorly formed granulomas and MNGs. Conclusions Findings were consistent with a diagnosis of HP with RA-associated ILD. The patient's history of severe RA biased the diagnosis to one of RA-associated ILD and her occupational risk had been less emphatically addressed. Obtaining a thorough occupational history can uncover exposures to workplace respiratory hazards and may create opportunities for intervention to limit morbidity from chronic lung disease. Copyright The Author 2017.en_US
dc.description.urihttps://doi.org/10.1093/occmed/kqx030en_US
dc.language.isoen_USen_US
dc.publisherOxford University Pressen_US
dc.relation.ispartofOccupational Medicine
dc.subjectHypersensitivity pneumonitisen_US
dc.subjectLung diseaseen_US
dc.subjectOccupational lung diseasesen_US
dc.subjectPulmonaryen_US
dc.titleUnabated occupational risk in a patient with rheumatoid pulmonary fibrosisen_US
dc.typeArticleen_US
dc.identifier.doi10.1093/occmed/kqx030
dc.identifier.pmid28339739


This item appears in the following Collection(s)

Show simple item record