Bird breeder’s disease: a rare diagnosis in young children
Tóm tắt
Bird breeder’s lung disease is the most common form of hypersensitivity pneumonitis and is a rare entity in young children. We report three cases of children under 7 years of age in whom this diagnosis was confirmed early in the course of the disease. Three children aged 4.4 to 6.5 years presented with dry cough lasting for more than 1 month, dyspnoea, variable loss of appetite, weight loss, fatigue, fever and mild signs of respiratory distress. Chest X-ray films and CT scans showed a bilateral micronodular infiltrate. All three patients had strongly suggestive bronchoalveolar lavage fluid findings with lymphocytosis; two had elevated cell counts and decreased CD4/CD8 ratios. Lung biopsy confirmed the diagnosis in all children. Contact with allergens was identified in all children: two had spent holidays close to a farm in the previous month and one was living next to a pigeon house. In all children, avian precipitins were positive. The symptoms rapidly resolved after allergen avoidance and treatment with oral prednisone. Corticoid treatment was given between 11 and 15 weeks. One child relapsed and required long-term low-dose corticotherapy for 1 year. Lung function tests were normal in all three patients, 3.9 to 5.7 years after diagnosis. Conclusion:Bird breeder’s lung disease is a rare entity but should be considered in young children presenting long lasting cough. While rapid allergen exclusion and start of treatment can avoid the evolution into irreversible lung fibrosis, clinical and biological evolution should be monitored carefully even after stopping corticoid treatment because of the possibility of relapse.
Tài liệu tham khảo
Bourke SJ, Dalphin JC, Boyd G, McSharry C, Baldwin CI, Calvert JE (2001) Hypersensitivity pneumonitis: current concepts. Eur Respir J 18[Suppl. 32]: 81–92
Camarena A, Juarez A, Meija M (2001) Major histocompatibility complex and tumor necrosis factor-α polymorphisms in pigeon breeder’s disease. Am J Respir Crit Care Med 163: 1528–1533
Clement A (2004) Task Force on chronic interstitial lung disease in immunocompetent children. Eur Respir J 24: 686–697
Clement A, Henrion-Caude A, Fauroux B (2004) The pathogenesis of interstitial lung diseases in children. Paediatr Respir Rev 5: 94–97
Delacourt C (1999) Alvéolite allergique extrinsèque. Arch Pédiatr 6[Suppl. 1]: 83–86
Eisenberg JD, Montanero A, Lee RG (1992) Hypersensitivity pneumonitis in an infant. Pediatr Pulmonol 12: 186–190
ESR Task force on bronchoalveolar lavage in children (2000) Bronchoalveolar lavage in children. Eur Respir J 15: 217–231
Fan LL (2002) Hypersensitivity pneumonitis in children. Curr Opin Pediatr 14: 323–326
Grech V, Vella C, Lenicker H (2000) Pigeon breeder’s lung in childhood: varied clinical picture at presentation. Pediatr Pulmonol 30: 145–148
Grimfeld A, Gaultier Cl, Baculard A, Le Moing G, Tournier G, Gerbeaux J (1981) Pneumopathies par hypersensibilité chez l’enfant. A propos de 5 cas. Sem Hop Paris 57: 1267–1272
Leland LF (2002) Hypersensitivity pneumonitis in children. Curr Opin Pediatr 14: 323–326
Levenson T, Patterson R (1996) Chronic cough in a child. Ann Allergy Asthma Immunol 76: 311–316
Lindemann H, Keller F, Velcovsky HG (1982) Exogene allergische Alveolitis im Kindesalter. Ergeb Inn Med Kinderheilkd 50: 1–30
Patel AM, Ryu JH, Reed CE (2001) Hypersensitivity pneumonitis: current concepts and future questions. J Allergy Clin Immunol 108: 661–670
Ratjen F, Costabel U, Griese M, Paul K (2003) Bronchoalveolar lavage fluid findings in children with hypersensitivity pneumonitis. Eur Respir J 21: 144–148
Reed CE, Sosman A, Barbee A (1965) Pigeon-breeder’s lung: a newly observed interstitial pulmonary disease. JAMA 193: 81–85
Reynaud C, Slosman DO, Polla BS (1990) Precipitins in bird breeder’s disease: how useful are they? Eur Respir J 3: 1155–1161
Severien C, Artlich A, Jonas S (1998) Die Taubenzüchterlunge im Kindesalter. Klin Pädiatr 210: 413–417
Stiehm ER, Reed CE, Tooley WH (1967) Pigeon breeder’s lung in children. Pediatrics 39: 904–915
Wolf SJ, Stillerman A, Weinberger M, Smith W (1987) Chronic interstitial pneumonitis in a 3-year-old child with hypersensitivity to dove antigens. Pediatrics 79: 1027–1028
Zacharisen MC, Schlueter DP, Kurup VP, Fink JN (2002) The long-term outcome in acute, subacute and chronic forms of pigeon’s breeder’s disease hypersensitivity pneumonitis. Ann Allergy Asthma Immunol 88: 175–182