Hypersenitivity Pneumonitis / pulmo infiltrates with eosinophilia Flashcards
another name for hypersensitivity pneumonitis
extrinsic allergic alveolitis
inflammatory response to inhaled antigens affect alveoli and small airways
true or false.smokers are more prone to develop HP
false.
there is an unexplained decreased risk in smokers
the type of established immunologic mechanism seen in HP
immune complex mediated reaction
inflammatory pattern: involves TH1
seen with continued low level antigen exposure or repeated episodes
irreversible respiratory impairment NOT responsive to removal of antigen
chronic form HP
occurs 4-8 hours after exposure of antigen
resolves within hours to a few days
acute form of HP
what are the 6 predictors of HP
- exposure to known antigen
- presence of serum precipitins
- recurrent symptoms
- inspiratory crackles
- symptoms after 4-8 hrs after exposure
- weight loss
mainstay treatment for HP
antigen avoidance
type of HP where PROMPT Glucocorticoids are needed for relief of symptoms
subacute HP
prednisone 0.5 - 1 mkd for 1-2 weeks, then taper over next 2-6 weeks
acute HP - no role
chronic HP - trial of glucocorticoid
antigen: penicillum casei, aspergillus clavatus
cheese washer’s lung
thermophilic actinomycetes, mushroom spores
mushroom worker’s lung
antigen: sitophilus granarius
miller’s lung
antigen: cladosporium species, mycobacterium avium complex
hot tub lung
antigen: bacillus subtilis
detergent worker’s lung
pulmonary infiltrates (on imaging) + increased eosinophils in lung tissue, sputum, BAL, + peripheral eosinophilia
pulmonary infiltrates with eosinophilia
antigen: botrytis cinerea
winemaker’s lung
boty = bote = bottle of WINE 😅
antigen: trichosporon cutaneum
summer-type pneumonitis
Churg Strauss Syndrome ( eosinophilic granulomatosis with polyangiitis) is a?
a. primary pulmonary eosinophilic disorder
b. pulmonary d/o of known cause assoc. with eosinophilia
c. systemic disease assoc. with eosinophilia
primary pulmonary eosinophilic disorders
others: acute and chronic eosinophilic pneumonia, hypereosinophilic syndrome (ACEH)
what are the 4 diagnostic criteria for acute eosinophilic pneumonia
- fever with respi symptoms of <1 month duration
- hypoxemic respiratory failure
- diffuse pulmo infiltrates
- BAL >25%
often seen in males in 20-40yrs
no organ dysfunction
high degree of corticosteroid responsiveness
what primary pulmonary eosinophilic disorder carry a poor prognosis due to myocardial, GI, and renal involvement?
eosinophilic granulomatosis with polyangiitis (EGPA)
heart is a primary target organ in EGPA
what primary pulmonary eosinophilic disorder is known to be less responsive to corticosteroids? (<50%)
hypereosinophilic syndrome (HES)
heterogenous group of diseases with persistent eosinophilia >1500/uL + end organ damage in the absence of secondary causes of eosinophilia.
not associated with ANCA or elevated IgE
hypereosinophilic syndromes
HES subtype often responsive to imatinib
PDGFRa -associated HES
possible complication of allergic bronchopulmonary fibrosis (ABPA)
cystic fibrosis
ABPA - aspergillus species, peripheral eosinophilia and elevated circulating IgE >417 IU/mL
