SHM Converge Scientific Abstract ePoster Gallery-Acute Hypoxic Respiratory Failure in a Healthy Young Adult: What Is His Occupation?

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A 41-year-old previously healthy, non-smoking man presented with one week of progressive cough and shortness of breath. He worked at a hay farm for the past year, which became an important exposure history. On admission, he was tachycardic and tachypneic with severe hypoxemia (oxygen saturation 82% on room air), requiring escalation from nasal cannula to high-flow oxygen. Lung exam showed decreased breath sounds bilaterally. Laboratory studies demonstrated leukocytosis with neutrophilic predominance and elevated CRP, while BMP and LFTs were normal.<br /><br />Chest CT showed extensive bilateral ground-glass opacities and diffuse interstitial thickening. Initial differential diagnosis included hypersensitivity pneumonitis, multifocal community-acquired pneumonia, and acute eosinophilic pneumonitis. He was started on ceftriaxone, doxycycline, and steroids. Infectious workup, including urinary antigens for Streptococcus pneumoniae and Legionella, was negative, and sputum culture showed no growth.<br /><br />Given the occupational exposure to hay, a hypersensitivity pneumonitis panel was sent and returned positive on day 3 for Micropolyspora faeni antibody, strongly supporting hypersensitivity pneumonitis (“farmer’s lung”). Antibiotics were discontinued, and intravenous methylprednisolone was continued. The patient’s respiratory status improved progressively, and he was discharged on a steroid taper.<br /><br />The case highlights hypersensitivity pneumonitis as an immune-mediated granulomatous interstitial lung disease triggered by inhaled antigens in susceptible individuals. Diagnosis relies on clinical history, imaging, serum IgG testing, and sometimes bronchoalveolar lavage. In this patient, a careful occupational history and positive antibody testing made BAL unnecessary.

Asset Subtitle

Prakash Adhikari

Meta Tag

Author List Imran Khokhar, Navanita Biswas, Prakash Adhikari

Category Clinical Vignettes

Concept Hypersensitivity Pneumonitis

Concept Antigen Avoidance

Concept Ground-Glass Opacities

Concept Occupational Exposure

Concept Environmental exposure

Distinguished Non-Finalist

Presenter Organization Tower Health-Reading Hospital

Presenting Author Prakash Adhikari

Track Adult

Keywords

hypersensitivity pneumonitis

farmer's lung

Micropolyspora faeni

hay farm exposure

ground-glass opacities

interstitial lung disease

acute hypoxemia

occupational lung disease

steroid therapy

bronchoalveolar lavage

Hypersensitivity Pneumonitis

Antigen Avoidance

Ground-Glass Opacities

Occupational Exposure

Environmental exposure