Case 40

 A seventy four-year-old female came to our hospital for dyspnea at rest which was continuing for a while but spontaneously improved. This symptom initiated two weeks before she was coming and occurred a few times a day. The similar symptoms of cough and yellowish sputum had been found at the same month of last year. At that time, the symptoms had continued for approximately one month. She lived in a thirty-year-old woody house with auto-washing air conditioner. Laboratory test at present revealed white blood cells 6010 /mm3, CRP 0.48 mg/dL, eosinophil 6.7 % (0-7) and non-specific IgE 743 IU/ml(14-400). Laboratory test last year revealed white blood cells 6900/mm3, CRP 0.53mg/dL, eosinophil 6.9% (0-7) and non-specific IgE 866 IU/ml(14-400).
 Chest radiograph (Fig. 1) and chest CT last year (Figs. 2, 3) and chest CT at present (Figs. 4, 5) were shown.

Which heading is correct about hypersensitivity pneumonitis?

a. Dry cough, dyspnea and malaise

b. Ig G related alveolitis

c. Three categories: acute,subacute and chronic

d. Onset age: over forties

e. Ground glass opacity on CT or chest radiograph

(1)a, b, c 　 (2) b, c, d 　 (3) c, d, e　 (4) a, c, d 　 (5) all

answer

2017.1.18