Clinico- pathologic presentation of hypersensitivity pneumonitis in Egyptian patients: a multidisciplinary study

Dalia Abd El-Kareem, Yosri M. Akl, Gina A. Nakhla, Ali A. Elhindawi, Mahmoud A. Eltorky

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Hypersensitivity pneumonitis (HP) is a common diffuse parenchymal lung disease in Egypt which can be difficult to recognize due to the dynamic symptoms & associated environmental factors. Methods: Forty-three Egyptian patients were enrolled in this study, presenting with dyspnea and cough, predominant ground-glass opacity (GGO) in high-resolution computed tomography (HRCT) where lung biopsy was needed to establish the diagnosis. Results: The age range was 15 to 60 years. Females represented 90.7% (39 patients) while 9.3% (4 patients) of our patients were males. History of contact with birds was detected in 9 (20.9%) patients. Most of our patients (60.5%) didn’t have exposure history, and only 8 patients (18.6%) were living in geographic areas in Egypt that are known for the exposure to environmental etiologic factors (cane sugar exhaust fumes). The most common HRCT pattern was GGO with mosaic parenchyma in 18 patients (41.86%), followed by GGO with centrilobular nodules in 9 patients (20.93%), then isolated diffuse GGO in 5 patients (11.62%), GGO with traction bronchiectasis in 4 patients (9.3%), GGO with consolidation in 3 patients (6.97%), GGO with reticulations in 2 patients (4.65%), and GGO with cysts in 2 patients (4.65%). The most common histologic finding was isolated multinucleated giant cells in 38 patients (88.3%) commonly found in airspaces (24 patients) and less commonly in the interstitium (14 patients), followed by interstitial pneumonia and cellular bronchiolitis in 36 patients (83.7% each), interstitial ill-formed non-necrotizing granulomas in 12 patients (27.9%), fibrosis in 10 patients (23.2%), and organizing pneumonia pattern in 4 patients (9.3%). Conclusion: The diagnosis of HP presenting with predominant GGO pattern in HRCT requires a close interaction among clinicians, radiologists, and pathologists. Some environmental and household factors may be underestimated as etiologic factors. Further environmental and genetic studies are needed especially in patients with negative exposure history.

Original languageEnglish (US)
Article number10
JournalMultidisciplinary Respiratory Medicine
Volume12
Issue number1
DOIs
StatePublished - May 8 2017

Fingerprint

Extrinsic Allergic Alveolitis
Glass
Egypt
Interstitial Lung Diseases
Tomography
History

Keywords

  • Diffuse parenchymal lung diseases
  • Hypersensitivity pneumonitis
  • Interstitial lung diseases
  • Multidisciplinary approach

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Clinico- pathologic presentation of hypersensitivity pneumonitis in Egyptian patients : a multidisciplinary study. / Abd El-Kareem, Dalia; Akl, Yosri M.; Nakhla, Gina A.; Elhindawi, Ali A.; Eltorky, Mahmoud A.

In: Multidisciplinary Respiratory Medicine, Vol. 12, No. 1, 10, 08.05.2017.

Research output: Contribution to journalArticle

Abd El-Kareem, Dalia ; Akl, Yosri M. ; Nakhla, Gina A. ; Elhindawi, Ali A. ; Eltorky, Mahmoud A. / Clinico- pathologic presentation of hypersensitivity pneumonitis in Egyptian patients : a multidisciplinary study. In: Multidisciplinary Respiratory Medicine. 2017 ; Vol. 12, No. 1.
@article{bd52eddd8c1a479f9c698555e99b7ff4,
title = "Clinico- pathologic presentation of hypersensitivity pneumonitis in Egyptian patients: a multidisciplinary study",
abstract = "Background: Hypersensitivity pneumonitis (HP) is a common diffuse parenchymal lung disease in Egypt which can be difficult to recognize due to the dynamic symptoms & associated environmental factors. Methods: Forty-three Egyptian patients were enrolled in this study, presenting with dyspnea and cough, predominant ground-glass opacity (GGO) in high-resolution computed tomography (HRCT) where lung biopsy was needed to establish the diagnosis. Results: The age range was 15 to 60 years. Females represented 90.7{\%} (39 patients) while 9.3{\%} (4 patients) of our patients were males. History of contact with birds was detected in 9 (20.9{\%}) patients. Most of our patients (60.5{\%}) didn’t have exposure history, and only 8 patients (18.6{\%}) were living in geographic areas in Egypt that are known for the exposure to environmental etiologic factors (cane sugar exhaust fumes). The most common HRCT pattern was GGO with mosaic parenchyma in 18 patients (41.86{\%}), followed by GGO with centrilobular nodules in 9 patients (20.93{\%}), then isolated diffuse GGO in 5 patients (11.62{\%}), GGO with traction bronchiectasis in 4 patients (9.3{\%}), GGO with consolidation in 3 patients (6.97{\%}), GGO with reticulations in 2 patients (4.65{\%}), and GGO with cysts in 2 patients (4.65{\%}). The most common histologic finding was isolated multinucleated giant cells in 38 patients (88.3{\%}) commonly found in airspaces (24 patients) and less commonly in the interstitium (14 patients), followed by interstitial pneumonia and cellular bronchiolitis in 36 patients (83.7{\%} each), interstitial ill-formed non-necrotizing granulomas in 12 patients (27.9{\%}), fibrosis in 10 patients (23.2{\%}), and organizing pneumonia pattern in 4 patients (9.3{\%}). Conclusion: The diagnosis of HP presenting with predominant GGO pattern in HRCT requires a close interaction among clinicians, radiologists, and pathologists. Some environmental and household factors may be underestimated as etiologic factors. Further environmental and genetic studies are needed especially in patients with negative exposure history.",
keywords = "Diffuse parenchymal lung diseases, Hypersensitivity pneumonitis, Interstitial lung diseases, Multidisciplinary approach",
author = "{Abd El-Kareem}, Dalia and Akl, {Yosri M.} and Nakhla, {Gina A.} and Elhindawi, {Ali A.} and Eltorky, {Mahmoud A.}",
year = "2017",
month = "5",
day = "8",
doi = "10.1186/s40248-017-0091-6",
language = "English (US)",
volume = "12",
journal = "Multidisciplinary Respiratory Medicine",
issn = "1828-695X",
publisher = "Novamedia s.r.l.",
number = "1",

}

TY - JOUR

T1 - Clinico- pathologic presentation of hypersensitivity pneumonitis in Egyptian patients

T2 - a multidisciplinary study

AU - Abd El-Kareem, Dalia

AU - Akl, Yosri M.

AU - Nakhla, Gina A.

AU - Elhindawi, Ali A.

AU - Eltorky, Mahmoud A.

PY - 2017/5/8

Y1 - 2017/5/8

N2 - Background: Hypersensitivity pneumonitis (HP) is a common diffuse parenchymal lung disease in Egypt which can be difficult to recognize due to the dynamic symptoms & associated environmental factors. Methods: Forty-three Egyptian patients were enrolled in this study, presenting with dyspnea and cough, predominant ground-glass opacity (GGO) in high-resolution computed tomography (HRCT) where lung biopsy was needed to establish the diagnosis. Results: The age range was 15 to 60 years. Females represented 90.7% (39 patients) while 9.3% (4 patients) of our patients were males. History of contact with birds was detected in 9 (20.9%) patients. Most of our patients (60.5%) didn’t have exposure history, and only 8 patients (18.6%) were living in geographic areas in Egypt that are known for the exposure to environmental etiologic factors (cane sugar exhaust fumes). The most common HRCT pattern was GGO with mosaic parenchyma in 18 patients (41.86%), followed by GGO with centrilobular nodules in 9 patients (20.93%), then isolated diffuse GGO in 5 patients (11.62%), GGO with traction bronchiectasis in 4 patients (9.3%), GGO with consolidation in 3 patients (6.97%), GGO with reticulations in 2 patients (4.65%), and GGO with cysts in 2 patients (4.65%). The most common histologic finding was isolated multinucleated giant cells in 38 patients (88.3%) commonly found in airspaces (24 patients) and less commonly in the interstitium (14 patients), followed by interstitial pneumonia and cellular bronchiolitis in 36 patients (83.7% each), interstitial ill-formed non-necrotizing granulomas in 12 patients (27.9%), fibrosis in 10 patients (23.2%), and organizing pneumonia pattern in 4 patients (9.3%). Conclusion: The diagnosis of HP presenting with predominant GGO pattern in HRCT requires a close interaction among clinicians, radiologists, and pathologists. Some environmental and household factors may be underestimated as etiologic factors. Further environmental and genetic studies are needed especially in patients with negative exposure history.

AB - Background: Hypersensitivity pneumonitis (HP) is a common diffuse parenchymal lung disease in Egypt which can be difficult to recognize due to the dynamic symptoms & associated environmental factors. Methods: Forty-three Egyptian patients were enrolled in this study, presenting with dyspnea and cough, predominant ground-glass opacity (GGO) in high-resolution computed tomography (HRCT) where lung biopsy was needed to establish the diagnosis. Results: The age range was 15 to 60 years. Females represented 90.7% (39 patients) while 9.3% (4 patients) of our patients were males. History of contact with birds was detected in 9 (20.9%) patients. Most of our patients (60.5%) didn’t have exposure history, and only 8 patients (18.6%) were living in geographic areas in Egypt that are known for the exposure to environmental etiologic factors (cane sugar exhaust fumes). The most common HRCT pattern was GGO with mosaic parenchyma in 18 patients (41.86%), followed by GGO with centrilobular nodules in 9 patients (20.93%), then isolated diffuse GGO in 5 patients (11.62%), GGO with traction bronchiectasis in 4 patients (9.3%), GGO with consolidation in 3 patients (6.97%), GGO with reticulations in 2 patients (4.65%), and GGO with cysts in 2 patients (4.65%). The most common histologic finding was isolated multinucleated giant cells in 38 patients (88.3%) commonly found in airspaces (24 patients) and less commonly in the interstitium (14 patients), followed by interstitial pneumonia and cellular bronchiolitis in 36 patients (83.7% each), interstitial ill-formed non-necrotizing granulomas in 12 patients (27.9%), fibrosis in 10 patients (23.2%), and organizing pneumonia pattern in 4 patients (9.3%). Conclusion: The diagnosis of HP presenting with predominant GGO pattern in HRCT requires a close interaction among clinicians, radiologists, and pathologists. Some environmental and household factors may be underestimated as etiologic factors. Further environmental and genetic studies are needed especially in patients with negative exposure history.

KW - Diffuse parenchymal lung diseases

KW - Hypersensitivity pneumonitis

KW - Interstitial lung diseases

KW - Multidisciplinary approach

UR - http://www.scopus.com/inward/record.url?scp=85018740955&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85018740955&partnerID=8YFLogxK

U2 - 10.1186/s40248-017-0091-6

DO - 10.1186/s40248-017-0091-6

M3 - Article

AN - SCOPUS:85018740955

VL - 12

JO - Multidisciplinary Respiratory Medicine

JF - Multidisciplinary Respiratory Medicine

SN - 1828-695X

IS - 1

M1 - 10

ER -