Feather duvet lung

Abstract

A 43-year-old non-smoker was referred with a 3-month history of malaise, fatigue and breathlessness. Blood avian precipitins were strongly positive. Lung function testing confirmed a restrictive pattern with impaired gas transfer. A 'ground glass' mosaic pattern was seen on CT imaging, suggestive of hypersensitivity pneumonitis. Although he had no pet birds, on closer questioning he had recently acquired a duvet and pillows containing feathers. His symptoms, chest radiograph and lung function tests improved after removal of all feather bedding, and he was also started on oral corticosteroid therapy. Our case reinforces the importance of taking a meticulous exposure history and asking about domestic bedding in patients with unexplained breathlessness. Prompt recognition and cessation of antigen exposure may prevent the development of irreversible lung fibrosis.

Keywords: interstitial lung disease; respiratory medicine.

Figure 1

Chest radiograph reported as ‘normal’ noting diffuse ground glass shadowing in all zones.

Figure 2

CT scan showing mosaic pattern apical axial view.

Figure 3

CT scan showing mosaic pattern middle zones axial view.

Figure 4

CT scan mediastinal axial slice with prominent reactive borderline enlarged mediastinal and hilar nodes.

Figure 5

Pulmonary function (% predicted) over time.