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Rea G, Bocchino M, Lieto R, Ledda RE, D’Alto M, Sperandeo M, Lucci R, Pasquinelli P, Sanduzzi Zamparelli S, Bocchini G, Valente T, Sica G. The Unveiled Triad: Clinical, Radiological and Pathological Insights into Hypersensitivity Pneumonitis. J Clin Med 2024; 13:797. [PMID: 38337490 PMCID: PMC10856167 DOI: 10.3390/jcm13030797] [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: 11/28/2023] [Revised: 01/10/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
Hypersensitivity pneumonitis (HP) is a diffuse parenchymal lung disease (DLPD) characterized by complex interstitial lung damage with polymorphic and protean inflammatory aspects affecting lung tissue targets including small airways, the interstitium, alveolar compartments and vascular structures. HP shares clinical and often radiological features with other lung diseases in acute or chronic forms. In its natural temporal evolution, if specific therapy is not initiated promptly, HP leads to progressive fibrotic damage with reduced lung volumes and impaired gas exchange. The prevalence of HP varies considerably worldwide, influenced by factors like imprecise disease classification, diagnostic method limitations for obtaining a confident diagnosis, diagnostic limitations in the correct processing of high-resolution computed tomography (HRCT) radiological parameters, unreliable medical history, diverse geographical conditions, heterogeneous agricultural and industrial practices and occasionally ineffective individual protections regarding occupational exposures and host risk factors. The aim of this review is to present an accurate and detailed 360-degree analysis of HP considering HRCT patterns and the role of the broncho-alveolar lavage (BAL), without neglecting biopsy and anatomopathological aspects and future technological developments that could make the diagnosis of this disease less challenging.
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Affiliation(s)
- Gaetano Rea
- Department of Radiology, Monaldi Hospital, Azienda Ospedaliera dei Colli, 80131 Naples, Italy; (G.R.); (R.L.); (G.B.); (T.V.)
| | - Marialuisa Bocchino
- Department of Clinical Medicine and Surgery, Section of Respiratory Diseases, University Federico II, Monaldi Hospital, Azienda Ospedaliera dei Colli, 80131 Naples, Italy;
| | - Roberta Lieto
- Department of Radiology, Monaldi Hospital, Azienda Ospedaliera dei Colli, 80131 Naples, Italy; (G.R.); (R.L.); (G.B.); (T.V.)
| | - Roberta Eufrasia Ledda
- Section of Radiology, Unit of Surgical Science, Department of Medicine and Surgery (DiMeC), University of Parma, 43121 Parma, Italy;
| | - Michele D’Alto
- Department of Cardiology, University “L. Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy;
| | - Marco Sperandeo
- Interventional Ultrasound Unit, Department of Internal Medicine, IRCCS “Casa Sollievo Della Sofferenza” Hospital, San Giovanni Rotondo, 71013 Foggia, Italy;
| | - Raffaella Lucci
- Department of Pathology, Monaldi Hospital, Azienda Ospedaliera dei Colli, 80131 Naples, Italy;
| | - Patrizio Pasquinelli
- Italian Federation of Pulmonary Fibrosis and Rare Pulmonary Diseases “FIMARP”, 00185 Rome, Italy;
- Department of Pulmonary Diseases, San Camillo-Forlanini Hospital, 00152 Rome, Italy
| | | | - Giorgio Bocchini
- Department of Radiology, Monaldi Hospital, Azienda Ospedaliera dei Colli, 80131 Naples, Italy; (G.R.); (R.L.); (G.B.); (T.V.)
| | - Tullio Valente
- Department of Radiology, Monaldi Hospital, Azienda Ospedaliera dei Colli, 80131 Naples, Italy; (G.R.); (R.L.); (G.B.); (T.V.)
| | - Giacomo Sica
- Department of Radiology, Monaldi Hospital, Azienda Ospedaliera dei Colli, 80131 Naples, Italy; (G.R.); (R.L.); (G.B.); (T.V.)
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Rachid C, Hindi M, Fikri O, Amro L. Diagnostic Approach to Hypersensitivity Pneumonitis: A Report of Two Cases. Cureus 2023; 15:e43290. [PMID: 37577266 PMCID: PMC10414688 DOI: 10.7759/cureus.43290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2023] [Indexed: 08/15/2023] Open
Abstract
Hypersensitivity pneumonitis (HP) is a bronchopulmonary granulomatosis of immunological mechanism, caused by an aberrant response to an inhaled exposure, which results in mostly T cell-mediated inflammation, granuloma formation, and fibrosis in some cases. The most common forms are bird breeder's disease and farmer's lung disease. The diagnosis of HP is based on the presence of compatible symptoms, the notion of exposure to antigens known to be pathogenic, and the existence of interstitial and bronchiolar images on the thoracic scan, lymphocytosis in the alveolar lavage, and precipitins. Chronic forms, in case of insidious exposure, especially in poultry, may evolve into pulmonary fibrosis with a poor prognosis. Through this work, we want to underline the frequency of this disease in our country, its heterogeneity as well as the difficult early diagnosis. Finally, we will investigate the therapeutic effect of corticosteroids in the early stages and the antifibrotic treatment in fibrotic forms.
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Affiliation(s)
- Chaynez Rachid
- Pneumology Department, Chu Mohammed VI, Laboratoire de Recherche Morpho Sciences, Faculté de médecine et de Pharmacie de Marrakech, Université Cadi Ayyad (Labo LRMS, FMPM, UCA) Hopital Arrazi, Marrakesh, MAR
| | - Meryem Hindi
- Pneumology Department, Chu Mohammed VI, Laboratoire de Recherche Morpho Sciences, Faculté de médecine et de Pharmacie de Marrakech, Université Cadi Ayyad (Labo LRMS, FMPM, UCA) Hopital Arrazi, Marrakesh, MAR
| | - Oussama Fikri
- Pneumology Department, Chu Mohammed VI, Laboratoire de Recherche Morpho Sciences, Faculté de médecine et de Pharmacie de Marrakech, Université Cadi Ayyad (Labo LRMS, FMPM, UCA) Hopital Arrazi, Marrakesh, MAR
| | - Lamyae Amro
- Pneumology Department, Chu Mohammed VI, Laboratoire de Recherche Morpho Sciences, Faculté de médecine et de Pharmacie de Marrakech, Université Cadi Ayyad (Labo LRMS, FMPM, UCA) Hopital Arrazi, Marrakesh, MAR
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Hypersensitivity pneumonitis: An infrequent cause of chronic lung fibrosis in Africa? Afr J Thorac Crit Care Med 2022; 28:10.7196/AJTCCM.2022.v28i4.283. [PMID: 36911655 PMCID: PMC9994531 DOI: 10.7196/ajtccm.2022.v28i4.283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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