Occupational fibrotic hypersensitivity pneumonia in a halogen dishes manufacturer: A case report

Abstract

Background: Fibrotic hypersensitivity pneumonitis (FHP) is an allergic and diffuse pneumonia caused by repeated inhalation of antigenic substances, and sometimes developed in people working in specific environments. While novel antigens and exposures continued to be described, physicians should maintain a high suspicion of potential exposures. A detailed assessment of the patient's occupational exposures as well as living environment is necessary and complete allergen avoidance is the first and most important step in the management of FHP once the allergens are determined.

Case summary: A 35-year-old female was admitted to the hospital with a cough and breathing difficulties for more than one year. She was a nonsmoker and a manufacturer of halogen dishes, which are characteristic Chinese foods, for 15 years without any protection. High resolution computed tomography of the chest demonstrated an interstitial pneumonia pattern. Pulmonary function examination showed restricted ventilation dysfunction and a significant reduction in dispersion ability. Cell differentiation in bronchoalveolar lavage fluid demonstrated lymphocytosis (70.4%) with an increased lymphocyte CD4/CD8 ratio (0.94). Transbronchial lung biopsy combined with lung puncture pathology showed diffuse uniform alveolar interval thickening, chronic inflammatory cell infiltration, a proliferation of tissue in the bronchial wall fiber and alveolar epithelial follicle degeneration, resulting in fibrosis.

Conclusion: Exposure to spices used for the production of halogen dishes may cause FHP.

Keywords: Case report; Fibrotic hypersensitivity pneumonitis; Halogen dishes; Inhalation; Interstitial pneumonia; Spices.

Figure 1

Chest high-resolution computed tomography (HRCT) images. A-C: showing traction bronchiectasis and extensive fibrosis, reticular changes (especially in the outer lung band and the double lower lung); D-F: showing the corresponding mediastinal window.

Figure 2

Pathological findings of transbronchial lung biopsy (TBLB) and computed tomography (CT)-guided percutaneous lung puncture, hematoxylin and eosin staining (×400). A: chronic lymphocyte infiltration; B: foamy macrophages infiltration and diffuse, relatively uniform alveolar septal thickness; C: hyperplasia of fibrous tissue in the bronchial wall, resulting in fibrosis.