Hypersensitivity pneumonitis in a Pleurotus mushroom grower
More details
Hide details
7th Pulmonary Department and Asthma Center, Athens Chest Hospital, Greece
Pneumon 2015;28(2):179-184
A 47 year old woman presented to the emergency department due to persistent productive cough, accompanied by breathlessness on exertion, chest pain and weight loss during the last three months. She was an occasional smoker and had been working as a mushroom grower of the Pleurotus species during the past six months, with an otherwise unremarkable medical history. An earlier chest CT scan, performed forty days previously, revealed bilateral patchy ground glass opacities, more profound in the upper lobes. One month before presentation she underwent bronchoscopy in another hospital and the cytological examination of the collected bronchoalveolar lavage (BAL) demonstrated excessive neutrophilia. She received at that time a course of antibiotic therapy with doxycyclin and amoxicillin/clavulanate, without clinical improvement. During hospitalization in our department, the patient underwent again bronchoscopy with BAL, revealing significant lymphocytosis (32%), additionally to the previously observed neutrophilia (43%). Given the compatible occupational history, the radiologic pattern and the BAL subpopulation analysis, a diagnosis of hypersensitivity pneumonitis was made and the patient was discharged with a recommendation to withdraw from her current occupational activity. Six weeks later, the patient presented evident clinical, imaging and functional improvement.
All the authors declare that they do not have a financial relationship with a commercial entity that has an interest in the subject of this manuscript.
Fink JN, Ortega HG, Reynolds HY, et al. Needs and opportunities for research in hypersensitivity pneumonitis. Am J Respir Crit Care Med 2005;171:792-8.
Lacasse Y, Selman M, Costabel U, et al. HP Study Group. Clinical diagnosis of hypersensitivity pneumonitis. Am J Respir Crit Care Med 2003;168: 952-8.
Selman M, Pardo A, King TE. Hypersensitivity pneumonitis: insights in diagnosis and pathobiology. Am J Respir Crit Care Med 2012;186:314-24.
Ohshimo S, Bonella F, Guzman J, Costabel H. Hypersensitivity Pneumonitis. Immunol Allergy Clin N Am 2012;32:537-56.
Dhar S, Daroowalla F. Hypersensitivity Pneumonitis. Clin Pulm Med 2011;18:169-74.
Solaymani-Dodaran M, West J, Smith C, Hubbard R. Extrinsic allergic alveolitis: incidence and mortality in the general population. QJM 2007;100:233-7.
Richerson HB, Bernstein IL, Fink JN, et al. Guidelines for the clinical evaluation of hypersensitivity pneumonitis. Report of the Subcommittee on Hypersensitivity Pneumonitis. J Allergy Clin Immunol 1989;84:839-44.
Lacasse Y, Selman M, Costabel U, et al; HP Study Group. Classification of hypersensitivity pneumonitis: a hypothesis. Int Arch Allergy Immunol. 2009;149:161-6.
Hanak V, Golbin JM, Hartman TE, Ryu JH. High-resolution CT findings of parenchymal fibrosis correlate with prognosis in hypersensitivity pneumonitis. Chest 2008;134:133-8.
Miyazaki Y, Tateishi T, Akashi T, Ohtani Y, Inase N, Yoshizawa Y. Clinical predictors and histologic appearance of acute exacerbations in chronic hypersensitivity pneumonitis. Chest 2008;134:1265-70.
Kuramochi J, Inase N, Miyazaki Y, Kawachi H, Takemura T, Yoshizawa Y. Lung cancer in chronic hypersensitivity pneumonitis. Respiration 2011;82:263-7.
Koschel DS, Cardoso C, Wiedemann B, Höffken G, Halank M. Pulmonary hypertension in chronic hypersensitivity pneumonitis. Lung 2012;190:295-302.
Trahan S, Hanak V, Ryu JH, Myers JL. Role of surgical lung biopsy in separating chronic hypersensitivity pneumonia from usual interstitial pneumonia/idiopathic pulmonary fibrosis: analysis of 31 biopsies from 15 patients. Chest 2008;134:126-32.
Churg A, Sin DD, Everett D, Brown K, Cool C. Pathologic patterns and survival in chronic hypersensitivity pneumonitis. Am J Surg Pathol 2009;33:1765-70.
Takemura T, Akashi T, Kamiya H, et al. Pathological differentiation of chronic hypersensitivity pneumonitis from idiopathic pulmonary fibrosis/usual interstitial pneumonia. Histopathology 2012;61:1026-35.
Jeong YJ, Lee KS, Chung MP, Han J, Johkoh T, Ichikado K. Chronic hypersensitivity pneumonitis and pulmonary sarcoidosis: differentiation from usual interstitial pneumonia using highresolution computed tomography. Semin Ultrasound CT MR 2014;35:47-58.
Lacasse Y, Girard M, Cormier Y. Recent advances in hypersensitivity pneumonitis. Chest 2012;142:208-17.
Selman M, Lacasse Y, Pardo A, Cormier Y. Hypersensitivity pneumonitis caused by fungi. Proc Am Thorac Soc 2010;7:229-36.
Winck JC, Delgado L, Murta R, Lopez M, Marques JA. Antigen characterization of major cork moulds in Suberosis (cork worker’s pneumonitis) by immunoblotting. Allergy 2004;59:739-45.
Cormier Y, Israël-Assayag E, Bédard G, Duchaine C. Hypersensitivity pneumonitis in peat moss processing plant workers. Am J Respir Crit Care Med 1998;158:412-17.
Baur X, Richter G, Pethran A, Czuppon AB, Schwaiblmair M. Increased prevalence of IgG-induced sensitization and hypersensitivity pneumonitis (humidifier lung) in nonsmokers exposed to aerosols of a contaminated air conditioner. Respiration 1992;59:211-4.
Reijula KE. Two common fungi associated with farmer’s lung: fine structure of Aspergillus fumigatus and Aspergillus umbrosus. Mycopathologia 1991;113:143-9.
Nakajima A, Saraya T, Mori T, et al. Familial summer-type hypersensitivity pneumonitis in Japan: two case reports and review of the literature. BMC Res Notes 2013;6:371.
Mori S, Nakagawa-Yoshida K, Tsuchihashi H, et al. Mushroom worker’s lung resulting from indoor cultivation of Pleurotus osteatus. Occup Med (Lond) 1998;48:465-8.
Bringhurst LS, Byrne RN, Gershon-Cohen J. Respiratory disease of mushroom workers; farmer’s lung. J Am Med Assoc 1959;171:15- 8.
Kaldis P, Kontogeorgakos D, Gardeli C. Economic aspects of the emerging Greek mushrooms industry. New Medit 2002;3.
Van den Bogart HG, Van den Ende G, Van Loon PC, Van Griensven LJ. Mushroom worker’s lung: serologic reactions to thermophilic actinomycetes present in the air of compost tunnels. Mycopathologia 1993;122:21-8.
Cox A, Folgering HT, van Griensven LJ. Extrinsic allergic alveolitis caused by spores of the oyster mushroom Pleurotus ostreatus. Eur Respir J 1988;1:466-8.
Sastre J, Ibáñez MD, López M, Lehrer SB. Respiratory and immunological reactions among Shiitake (Lentinus edodes) mushroom workers. Clin Exp Allergy 1990;20:13-9.
Van Loon PC, Cox AL, Wuisman OP, Burgers SL, Van Griensven LJ. Mushroom worker’s lung. Detection of antibodies against Shii-take (Lentinus edodes) spore antigens in Shii-take workers. J Occup Med 1992;34:1097-101.
Saikai T, Tanaka H, Fuji M, et al. Hypersensitivity pneumonitis induced by the spore of Pleurotus Eryngii (Eringi). Intern Med 2002;41:571-3.
Hirschmann JV, Pipavath SN, Godwin JD. Hypersensitivity pneumonitis: a historical, clinical, and radiologic review. Radiographics 2009;29:1921-38.
Sanderson W, Kullman G, Sastre J, et al. Outbreak of hypersensitivity pneumonitis among mushroom farm workers. Am J Ind Med 1992;22:859-72.
Cormier Y, Bélanger J, Durand P. Factors influencing the development of serum precipitins to farmer’s lung antigen in Quebec dairy farmers. Thorax 1985;40:138-42.
Fournier E, Tonnel AB, Gosset P, Wallaert B, Ameisen JC, Voisin C. Early neutrophil alveolitis after antigen inhalation in hypersensitivity pneumonitis. Chest 1985;88:563-6.
Drent M, van Velzen-Blad H, Diamant M, Wagenaar SS, Hoogsteden HC, van den Bosch JM. Bronchoalveolar lavage in extrinsic allergic alveolitis: effect of time elapsed since antigen exposure. Eur Respir J 1993;6:1276-81.
Mönkäre S, Haahtela T. Farmer’s lung--a 5-year follow-up of eighty-six patients. Clin Allergy 1987;17:143-51.
Kokkarinen JI, Tukiainen HO, Terho EO. Effect of corticosteroid treatment on the recovery of pulmonary function in farmer’s lung. Am Rev Respir Dis 1992;145:3-5.
Journals System - logo
Scroll to top