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A5649 - Bird Fancier's Lung in an Adolescent Female
Author Block: D. Cerrone; Division of Pulmonology and Sleep Medicine, Children's Hospital Los Angeles, Los Angeles, CA, United States.
A previously healthy female presented with a two month history of progressively worsened exertional dyspnea and 10 lbs weight loss. She initially became dyspneic with light exercise, however, by time of presentation to the emergency room her symptoms had progressed to the point she was unable to verbalize full sentences. Physicians in the community had previously diagnosed her with asthma, however, bronchodilator therapy provided no relief. She was also diagnosed with walking pneumonia and was treated with a course of azithromycin which also provided no relief. Initial evaluation in the emergency room included a chest radiograph which was unremarkable. A Chest CT was then obtained which incidentally revealed areas of air trapping in the left lower lobe. In light of her symptoms she was admitted to the hospital where exam was positive for presence of crackles at the left base. An echocardiogram was performed and was unremarkable and basic rheumatologic and oncologic workups were also obtained which were unremarkable. Of note, her symptoms began to progressively improve in hospital to her previous baseline. On further questioning she explained that she had five birds in her home environment and that she had never been away from her home since her symptoms began. In light of this a hypersensitivity panel was obtained. Complete pulmonary function testing was obtained when her symptoms improved and revealed a mild restrictive pattern with a total lung capacity of 69 percent predicted with no obstructive pattern. She was ultimately discharged after returning to her baseline state of health. She was seen in pulmonary clinic two weeks after discharge where her symptoms were noted to be severe. By this appointment her hypersensitivity panel returned positive for precipitating antibodies to pigeon. She was subsequently admitted to the hospital again where a bronchoscopy was performed which revealed lymphocytosis and an acute inflammatory profile. The diagnosis of Bird Fancier’s Lung was rendered and she was placed on intravenous steroids. Her symptoms normalized in hospital and birds were subsequently removed from her home. Repeat pulmonary function testing was completely normal and she has remained symptom free off steroids. The case highlights the importance of a thorough history and physical exam. This patient's history of bird exposure, weight loss, improvement when separated from the offending antigen, and finding of crackles on exam were classic for the diagnosis and may have precluded a lengthy, expensive workup.