Bird Fancier's Disease Due to Exposure to Birds Via a Desert Cooler
A 57-year-old female referred to Imam Khomeini hospital with chief complaint of exertional dyspnea. She lived in the southern parts of Tehran. Her dyspnea which began about 4 months before her admission to hospital was gradually progressive and was accompanied by non-purulent cough. At the time of her admission she had some problems for performing activities of daily living. Dyspnea did not occur during resting and sleep and was not related to the time of eating. She didn't complain of orthopnea and paroxysmal nocturnal dyspnea (PND). The history of hemoptysis and exposure to tuberculous patients was negative.\nIn her past medical history, she was under treatment for hyperlipidemia (atorvastatine) and hypothyroidism (levothyroxine). She didn’t mention the history of any other respiratory or cardiovascular diseases. She didn’t have any hypersensitivity to drugs or nutritious substances and the history of seasonal allergy was negative as well.\nHer family history was negative for respiratory and cardiovascular diseases. History of smoking, alcohol consumption and drug abuse was negative. She was a housewife without any specific occupational exposures. Her husband was a farmer who had been died due to cardiovascular diseases 9 years ago. She lives in the first floor of a 3-storey buildingin Tehran (She didn’t use to live in her husband's farm). Her house was not near any industrial plants.\nIn the physical examination, she was completely alert. Her vital signs included: Pulse rate: 78/min, respiratory rate: 20/min, temperature: 37.1°C, blood pressure: 110/75 mmHg. Her body mass index was 35.5 kg/m2. Lung field auscultation revealed inspiratory crackles in the bases of both lungs, especially right lung and to a lesser intensity in the mid-zones of both lungs.\nIn arterial blood gas analysis, O2 saturation was 78%, and other parameters were normal. The results of complete blood count included:\nWBC: 10900/mm3\nRBC: 6.66 × 106 ml/mm3\nHemoglobin: 18.6 g/dl\nHCT: 58.9%\nMCV: 88 fl\nMCHC: 28 pg\nPlt: 230000/mm3\nMPV: 8.5 fl\nRDW: 15.1%\nPoly: 63.3%\nLymph: 28.3%\nMono: 4.6%\nEos: 3.3%\nBaso: 0.5%\nAnisocytosis: Slight\nThe result of spirometry showed a severe restrictive pattern (FVC = 1 L, 47.3% of predicted) which was approved by body plethysmography (TLC = 2.97 lit, 76% of predicted). Diffusing capacity (DLCO) was decreased (73.9%). She showed a significant response to bronchodilator administration hence a 21% and 17.7% increase in FVC and FEV1, respectively. The purified protein derivative (PPD) test for TB was negative.\nExercise stress test was performed but not completed because of her dyspnea. The result of transthoracic echocardiography was as following:\nPAPs: 40 mmHg, LVEF = 55%, Normal RV size and systolic function, diastolic dysfunction grade 2, trivial MR, and mild TR\nChest X ray showed reticulo-nodular pattern in both lower lung fields (despite a normal chest X ray 6 months before). shows two chest X rays before and after onset of disease.\nHigh-resolution computed tomography (HRCT) scan results in inspiration and expiration was as following: Generalized ground glass opacities in both lung fields and hypo-dense areas due to focal emphysema. Multiple lobular, patchily dispersed areas of air trapping throughout pulmonary fields, on expiratory views, mostly accompanied by mosaic perfusion on the corresponding inspiratory phase views. Interlobular septa were unremarkable. Neither bronchiectasis nor bronchiolectasis was noted, on either side. Interlobular and peribronchchovascular interstitium were ordinary depicted. The main pulmonary artery was dilated. Cardiomegaly was depicted [].\nAfter observing the results of paraclinic tests, because of high suspicion of hypersensitivity pneumonitis, another history with details was obtained from her. She mentioned that her son keeps a considerable number of birds (doves) on the roof of the building and their cage was beside the desert cooler of the building. So she fulfilled the criteria of HP and after removing the exposure her symptoms subsided and her pulmonary function improved significantly hence FVC = 1.79l, 82% of predicted and FEV1 = 1.42l, 79% of predicted.\nA written informed consent was obtained from patient to publish her case report with her radiographic images. This consent is available (in Persian) for the journal editorial.