Hypersenitivity Pneumonitis / pulmo infiltrates with eosinophilia

Question 1

another name for hypersensitivity pneumonitis

Answer 1

extrinsic allergic alveolitis

inflammatory response to inhaled antigens affect alveoli and small airways

Question 2

true or false.smokers are more prone to develop HP

Answer 2

false.

there is an unexplained decreased risk in smokers

Question 3

the type of established immunologic mechanism seen in HP

Answer 3

immune complex mediated reaction

inflammatory pattern: involves TH1

Question 4

seen with continued low level antigen exposure or repeated episodes
irreversible respiratory impairment NOT responsive to removal of antigen

Answer 4

chronic form HP

Question 5

occurs 4-8 hours after exposure of antigen

resolves within hours to a few days

Answer 5

acute form of HP

Question 6

what are the 6 predictors of HP

Answer 6

1. exposure to known antigen
2. presence of serum precipitins
3. recurrent symptoms
4. inspiratory crackles
5. symptoms after 4-8 hrs after exposure
6. weight loss

Question 7

mainstay treatment for HP

Answer 7

antigen avoidance

Question 8

type of HP where PROMPT Glucocorticoids are needed for relief of symptoms

Answer 8

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

Question 9

antigen: penicillum casei, aspergillus clavatus

Answer 9

cheese washer’s lung

Question 10

thermophilic actinomycetes, mushroom spores

Answer 10

mushroom worker’s lung

Question 11

antigen: sitophilus granarius

Answer 11

miller’s lung

Question 12

antigen: cladosporium species, mycobacterium avium complex

Answer 12

hot tub lung

Question 13

antigen: bacillus subtilis

Answer 13

detergent worker’s lung

Question 14

pulmonary infiltrates (on imaging) + increased eosinophils in lung tissue, sputum, BAL, + peripheral eosinophilia

Answer 14

pulmonary infiltrates with eosinophilia

Question 15

antigen: botrytis cinerea

Answer 15

winemaker’s lung

boty = bote = bottle of WINE 😅

Question 16

antigen: trichosporon cutaneum

Answer 16

summer-type pneumonitis

Question 17

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

Answer 17

primary pulmonary eosinophilic disorders

others: acute and chronic eosinophilic pneumonia, hypereosinophilic syndrome (ACEH)

Question 18

what are the 4 diagnostic criteria for acute eosinophilic pneumonia

Answer 18

1. fever with respi symptoms of <1 month duration
2. hypoxemic respiratory failure
3. diffuse pulmo infiltrates
4. BAL >25%

often seen in males in 20-40yrs
no organ dysfunction
high degree of corticosteroid responsiveness

Question 19

what primary pulmonary eosinophilic disorder carry a poor prognosis due to myocardial, GI, and renal involvement?

Answer 19

eosinophilic granulomatosis with polyangiitis (EGPA)

heart is a primary target organ in EGPA

Question 20

what primary pulmonary eosinophilic disorder is known to be less responsive to corticosteroids? (<50%)

Answer 20

hypereosinophilic syndrome (HES)

Question 21

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

Answer 21

hypereosinophilic syndromes

Question 22

HES subtype often responsive to imatinib

Answer 22

PDGFRa -associated HES

Question 23

possible complication of allergic bronchopulmonary fibrosis (ABPA)

Answer 23

cystic fibrosis

ABPA - aspergillus species, peripheral eosinophilia and elevated circulating IgE >417 IU/mL