OCCUPATIONAL-HYPERSENSITIVITY PNEUMONITIS: A DIAGNOSIS NOT TO BE MISSED BY PROPER HISTORY TAKING

TOPIC: Occupational and Environmental Lung Diseases TYPE: Medical Student/Resident Case Reports INTRODUCTION: Hypersensitivity Pneumonitis (HP) is an inflammatory and/or fibrotic disease affecting the lung parenchyma. Radiographic or histopathological findings help to categorize HP as either (mixed plus purely fibrotic) non-fibrotic (purely inflammatory), being primary determinant of prognosis. Rarely acute respiratory decline can be first manifestation chronic that may develop within a wide timeframe from weeks years exposure. CASE PRESENTATION: A 38-year-old male with no comorbidities smoking history, presented one week progressive shortness breath. Further questions revealed since childhood he was working in car painting shop without using protective equipment. Vital signs: Temperature 36.9, pulse 98 beats/min, rate 22 breaths/min, blood pressure 116/96 mmHg, oxygen saturation 37% on room air, improved 98% via non-rebreather mask. He not distress. Findings included diffuse bilateral crackles over fields. CXR showed patchy alveolar opacities. WBC count serum procalcitonin were normal limits. SARS-CoV-2 PCR performed negative. Chest CT extensive consolidations, ground-glass opacities, honeycombing, prominent mediastinal lymph nodes. Given patient symptoms, high-risk exposure isocyanate which exists paints, radiologic findings, by ruling out infectious etiologies, suspected diagnosis made treatment IV Methylprednisone 60mg twice daily initiated. After 2 days, clinical status requirements decreased 8 LPM Nasal Cannula. Bronchoscopy erythema throughout tracheobronchial tree. Bronchoalveolar lavage (BAL) cytology showed: Reactive bronchial cells (24% Lymphocytes, 31% macrophages, 44% neutrophils). Consequently, chronic, confirmed. Finally, after completing 7 days steroid treatment, discharged home supplemental oxygen. Instructions regarding oral corticosteroid tapering 3 week-period provided. DISCUSSION: Diagnosis predominantly based identification, scan pattern, bronchoscopic/histopathological findings. BAL majority patients shows elevated cell greater than 20% lymphocytes this group responds therapy significantly. CONCLUSIONS: We would like emphasize high value taking detailed history detect causative agent Unprotected key leading further investigation including performing our patient. also recommend health care providers educate their proper safety equipment use, case occupational inducers. Prevention always better cure! REFERENCE #1: Raghu G, Remy-Jardin M, Ryerson CJ, Myers JL, Kreuter Vasakova et. al. hypersensitivity pneumonitis adults. An official ATS/JRS/ALAT practice guideline. Am J Respir Crit Care Med 2020; 202(3):e36–e69. #2: Koster MA, Thomson CC, Collins BF, Jenkins AR, Ruminjo JK G. adults, 2020 guideline: summary for clinicians. Ann Thorac Soc 2020. DISCLOSURES: disclosure file Manish Gugnani; No relevant relationships Irina Gutierrez Puentes, source=Web Response Julio Piedra Butina, Asieh TakallooBakhtiari,