1/3. Extrinsic allergic alveolitis from a proteolytic enzyme.BACKGROUND: subtilisins are proteolytic enzymes of bacterial origin found in detergents. They are high-molecular-weight antigens and have been implicated in allergic rhinitis and asthma. OBJECTIVE: This report describes a case of extrinsic allergic alveolitis due to subtilisins in a liquid cleaner. methods: Clinical, radiologic, and serologic information were used to make the diagnosis. CASE REPORT: A 53-year-old woman developed respiratory symptoms while working with a cleaner containing subtilisins. Her symptoms intensified in the work environment and improved away from work. A computed tomography scan demonstrated alveolar and interstitial infiltrates with subsequent scarring. A pulmonary function study revealed a restrictive pattern with diminished diffusion capacity. Bronchoalveolar lavage showed lymphocytosis and all cultures were negative. Precipitating antibodies to the enzyme were found in the patient's serum. Her symptoms improved once she changed her occupation. CONCLUSIONS: The combination of the patient's clinical history, physical, laboratory, and radiologic findings support the diagnosis of extrinsic allergic alveolitis from the enzyme contained in the cleaner.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/3. Chronic hypersensitivity pneumonitis caused by aspergillus complicated with pulmonary aspergilloma.A 57-year-old man consulted our hospital with a history of the gradual onset of dyspnea and a productive cough. Chest computed tomographic (CT) scans showed a nodular shadow in a cavity lesion, and reticulonodular, cystic, and ground-grass opacities in the bilateral lung fields with honeycombing. He was diagnosed as having pulmonary aspergilloma and idiopathic pulmonary fibrosis (IPF). As an outpatient, he suffered from dyspnea upon physical exertion with exacerbation of the high-resolution CT (HRCT) opacities. An inhalation provocation test for aspergillosis fumigatus was positive and chronic hypersensitivity pneumonitis (CHP) caused by aspergillus was finally diagnosed. Insidious CHP is sometimes misdiagnosed as IPF. The diagnosis of insidious CHP should be made on the basis of a detailed history, specific HRCT findings, and lymphocyte-dominant bronchoalveolar lavage fluid cell findings.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/3. hypersensitivity pneumonitis-like reaction and occupational asthma associated with 1,3-bis(isocyanatomethyl) cyclohexane pre-polymer.Twenty-three of 34 workers who had worked in the injection molding operation making polyurethane foam parts at an automobile parts manufacturing plant developed respiratory symptoms and/or systemic symptoms over a 2-month period following the full production use of a new diisocyanate paint that contained 1,3-bis(isocyanatomethyl)cyclohexane pre-polymer (BIC)(CAS #75138-76-0, 38661-72-2). At 3 months, all subjects underwent an interview, physical examination, pre- and post-shift pulmonary function tests, and either methacholine challenge test or bronchodilator challenge at an occupational health clinic. The most frequently cited symptoms were dyspnea (65%), cough (61%), chest tightness (57%), chills (57%), wheezing (30%), and myalgias, arthralgias, and nausea (26%). Thirteen subjects had either a positive methacholine challenge test or a positive response to bronchodilator challenge, making the overall prevalence of airway hyperresponsiveness 38%. The overall prevalence of hypersensitivity pneumonitis-like reactions among line operators in the injection molding process was 27%. This disease outbreak suggests that 1,3-bis(isocyanatomethyl)cyclohexane pre-polymer may cause asthma and hypersensitivity pneumonitis-like reactions. The use of BIC was discontinued 6 months after the first workers developed symptoms.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |