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Inukai Motokura Y, Higo H, Matsumoto C, Uno M, Fujiwara K, Terao T, Makimoto S, Higaki F, Matsuoka KI, Tokioka F, Maeda Y, Miyahara N. Remission of hypersensitivity pneumonitis after allogeneic hematopoietic stem cell transplantation. Respir Investig 2024; 62:759-761. [PMID: 38959673 DOI: 10.1016/j.resinv.2024.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 06/11/2024] [Accepted: 06/24/2024] [Indexed: 07/05/2024]
Abstract
A 50-year-old man was diagnosed with hypersensitivity pneumonitis caused by the environment of his bar owing to worsening symptoms, laboratory test results, and computed tomography images after an environmental inhalation challenge test. His hypersensitivity pneumonitis exacerbated despite receiving prednisolone 20 mg/day. The patient underwent allogeneic hematopoietic stem cell transplantation (HSCT) from a human leukocyte antigen-matched unrelated donor for myelodysplastic syndrome. No exacerbation of hypersensitivity pneumonitis was observed after HSCT. An environmental inhalation challenge test involving exposure to his bar confirmed the remission of hypersensitivity pneumonitis after HSCT. This case demonstrates that hypersensitivity pneumonitis can be remitted by HSCT.
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Affiliation(s)
- Yumi Inukai Motokura
- Department of Allergy and Respiratory Medicine, Okayama University Hospital, 2-5-1 Shikata-cho, Okayama, Okayama, 700-8558, Japan
| | - Hisao Higo
- Department of Allergy and Respiratory Medicine, Okayama University Hospital, 2-5-1 Shikata-cho, Okayama, Okayama, 700-8558, Japan.
| | - Chiaki Matsumoto
- Department of Allergy and Respiratory Medicine, Okayama University Hospital, 2-5-1 Shikata-cho, Okayama, Okayama, 700-8558, Japan
| | - Mari Uno
- Department of Allergy and Respiratory Medicine, Okayama University Hospital, 2-5-1 Shikata-cho, Okayama, Okayama, 700-8558, Japan
| | - Kanako Fujiwara
- Department of Hematology and Oncology, Okayama University Hospital, 2-5-1 Shikata-cho, Okayama, Okayama, 700-8558, Japan
| | - Toshiki Terao
- Department of Hematology and Oncology, Okayama University Hospital, 2-5-1 Shikata-cho, Okayama, Okayama, 700-8558, Japan
| | - Satoko Makimoto
- Department of Radiology, Okayama University Hospital, 2-5-1 Shikata-cho, Okayama, Okayama, 700-8558, Japan
| | - Fumiyo Higaki
- Department of Radiology, Okayama University Hospital, 2-5-1 Shikata-cho, Okayama, Okayama, 700-8558, Japan
| | - Ken-Ichi Matsuoka
- Department of Hematology and Oncology, Okayama University Hospital, 2-5-1 Shikata-cho, Okayama, Okayama, 700-8558, Japan
| | - Fumiaki Tokioka
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan
| | - Yoshinobu Maeda
- Department of Hematology and Oncology, Okayama University Hospital, Department of Hematology, Oncology and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama, Okayama, 700-8558, Japan
| | - Nobuaki Miyahara
- Department of Allergy and Respiratory Medicine, Okayama University Hospital, 2-5-1 Shikata-cho, Okayama, Okayama, 700-8558, Japan
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Iijima Y, Ejima M, Yamana T, Sonoda S, Shibata S, Shirai T, Okamoto T, Furusawa H, Tateishi T, Adachi T, Mori M, Kirimura S, Anzai T, Takahashi K, Miyazaki Y. Assessment of clinical relevance of antigen improves diagnostic accuracy of hypersensitivity pneumonitis. BMC Pulm Med 2024; 24:84. [PMID: 38355540 PMCID: PMC10865633 DOI: 10.1186/s12890-024-02849-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 01/04/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Exposure assessment is integral to the diagnosis of hypersensitivity pneumonitis (HP). Although the clinical relevance of exposed antigens is essential for the assessment, many of the previous guidelines or reports have only evaluated simple exposure histories or immunological tests. To overcome this problem, the Exposure Assessment Form (EAF) was developed as an assessment tool for classifying the exposure grade from G0 to G4. The EAF was modified from the description in the Japanese clinical practice guide 2022 for HP published by the Japanese Respiratory Society. METHODS One hundred and seventy-two consecutive patients with interstitial lung disease who underwent multidisciplinary discussion (MDD) at our hospital were retrospectively examined. We assessed whether the use of the EAF improved the diagnostic performance of the international guideline of HP. We also evaluated whether the exposure grade affected the prognosis of HP. RESULTS Even when a HP diagnosis was made with a confidence of 70% or higher according to the international guideline, less than half of these cases resulted in a final diagnosis of HP when the exposure grades were lower than G3. When the result of the EAF was integrated into the exposure definition of the international guideline, the specificity of the diagnostic performance improved, while sensitivity was maintained. Furthermore, HP patients with an exposure grade of G3 or higher showed a tendency to take a longer time to initiate medication. CONCLUSIONS This is the first study to evaluate the clinical relevance of possible antigens using the EAF. Assessing the exposure grade prevents overdiagnosis and improves the diagnostic performance of the international guideline.
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Affiliation(s)
- Yuki Iijima
- Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan
| | - Masaru Ejima
- Department of Respiratory Medicine, Japanese Red Cross Musashino Hospital, 1-26-1, Minamimachi, Musasshino-City, Tokyo, 180-8610, Japan
| | - Takashi Yamana
- Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan
| | - Shiro Sonoda
- Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan
| | - Sho Shibata
- Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan
| | - Tsuyoshi Shirai
- Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan
| | - Tsukasa Okamoto
- Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan
- Department of Pulmonary Immunotherapeutics, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan
| | - Haruhiko Furusawa
- Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan
| | - Tomoya Tateishi
- Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan
| | - Takuya Adachi
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan
| | - Mio Mori
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan
| | - Susumu Kirimura
- Department of Pathology, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan
| | - Tatsuhiko Anzai
- Department of Biostatistics, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan
| | - Kunihiko Takahashi
- Department of Biostatistics, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan
| | - Yasunari Miyazaki
- Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan.
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