Hypersensitivity Pneumonitis and Eosinophilic Pneumonia

by Carlo Raj, MD

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    Here we have a really hot topic, called Hypersensitivity pneumonitis. Clinically called Extrinsic allergic alveolitis. Now, lets go down here for one second, make sure that you are fully aware of what’s going on. And by that I mean, we had a discussion with occupational lung diseases where we looked at pneumoconiosis and in those, or in that discussion, we looked at asbestosis, we looked at silicosis, we looked at berylliosis and we looked at coalworker pneumoconiosis, didn’t we? Leave that behind and what we have here is a patient who, once again, is'nt occupation, but in this occupation, does not develop pneumoconiosis. Does not necessarily develop all the things that we talked about earlier, but ends up developing a “allergic type of issue” and inflammatory process. Now this is a group of mixed disorder. There’s a lot of research going on in terms of what exactly is the pathogenesis. And the one thing that I wish to keep very clear here is that you do not find necessarily an abundance of eosinophilia. Really? Yeah, you really don't. So, at some point, when we jump into our discussion of eosinophilic pneumonia, hypersensitivity pneumonitis is really not going to be part of that. Fascinating. So you want to be really careful as to how you use the word hypersensitivity and see as to whether or not... well, your patient got exposed to something, is now having a reaction and maybe a type III/type IV hypersensitivity. Type III, immune complex and type IV, your delayed type of hypersensitivity to environmental antigens resulting in dyspnoea, cough, chest tightness and headache. Okay. So, there will be… the cough, would be more or less your dry kind of cough, dyspnoea, interstitium is being involved. There will be chest tightness and headache. And by environmental antigens,...

    About the Lecture

    The lecture Hypersensitivity Pneumonitis and Eosinophilic Pneumonia by Carlo Raj, MD is from the course Disorders of the pulmonary circulation and the respiratory regulation. It contains the following chapters:

    • Hypersensitivity Pneumonitis
    • Eosinophilic Lung Disease (ELD)

    Included Quiz Questions

    1. …Tuberculosis
    2. …Sarcoidosis
    3. …Extrinsic allergic alveolitis
    4. …Crohn’s disease
    5. …Berylliosis
    1. Mix of delayed cell-mediated and immune complex disease
    2. Immediate allergic reaction
    3. Immune complex mediated
    4. Mix of immune complex and antibody dependent reaction
    5. Cytotoxic, antibody dependent reaction
    1. Productive cough
    2. Chest tightness
    3. Dyspnea
    4. Fever
    5. Headache
    1. …bronchiolitis obliterans.
    2. …mesothelioma.
    3. …Sarcoidosis.
    4. …Caplan syndrome.
    5. …adenocarcinoma of the lungs.
    1. Remove the offending antigen and observe if symptoms remit.
    2. Bronchoalveolar lavage
    3. Pulmonary function testing
    4. Corticosteroid therapy
    5. Chest radiograph
    1. …non-caseating granulomas.
    2. …pleural plaques.
    3. …pneumoconiosis.
    4. …cavitary lesions.
    5. …ferruginous bodies.
    1. Eosinophilia
    2. Periodicity symptoms
    3. Positive inhalation challenge test
    4. Noncaseating granuloma on histology
    5. Lymphocyte prodominant alveolar sputum sample
    1. Farmer’s lung – actinomycosis
    2. Byssinosis – cotton fiber protein
    3. Nylon flockers lung – nylon fiber protein
    4. Bagassosis – moldy sugar cane
    5. Silo fillers lung – nitrogen dioxide gas
    1. Lymphocytes with low CD4:CD8 ratio
    2. Predominantly CD4 lymphocytes
    3. Langhans’ giant cells
    4. Hemosiderin laden macrophages
    5. Eosinophils
    1. Reticular pattern on lung imaging
    2. Restrictive pattern on pulmonary function testing
    3. Excessive mucus production
    4. Non-caseating granuloma on lung biopsy
    5. Helminth infection
    1. Acetaminophen
    2. Nitrofurantoin
    3. Phenytoin
    4. L-tryptophan
    5. Minocycline
    1. Endomyocardial fibrosis
    2. Endocardial fibroelastosis
    3. Obstructive cardiomyopathy
    4. Myocardial abscess
    5. Cor pulmonale
    1. Paragonimiasis
    2. Trichinellosis
    3. Wucheria bancrofti
    4. Schistosomiasis
    5. Disseminated strongyloidiasis
    1. Once the helminth has invaded through the intestinal wall.
    2. Once the helminth has invaded the lung parenchyma.
    3. Once the helminth penetrates the host peripheral defenses.
    4. Once the helminth has deposited larvae in the intestine.
    5. Once the helminth has invaded the heart tissue.
    1. Chronic eosinophilic pneumonia
    2. Acute eosinophilic pneumonia
    3. Allergic asthma
    4. Bronchiecstasia
    5. Extrinsic allergic alveolitis
    1. History of exposure to pigeon feathers and excreta.
    2. Nonproductive cough
    3. Dypsnea
    4. Acute febrile illness less than 7 days
    5. Rapid progression in a previously healthy patient.
    1. Anti-myeloperoxidase antibodies
    2. Anti-CCP antibodies
    3. Anti-transglutaminase antibodies
    4. Anti-centromere antibodies
    5. Anti-proteinase 3 antibodies
    1. Septate hyphae on histology
    2. Aspergillus fumagatus
    3. Bronchocentric granulomatosis
    4. Cystic fibrosis
    5. Asthma

    Author of lecture Hypersensitivity Pneumonitis and Eosinophilic Pneumonia

     Carlo Raj, MD

    Carlo Raj, MD

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