SHM Converge Scientific Abstract ePoster Gallery-Fancy That! An Unexpected Cause of Postoperative Hypoxemia

Pdf Summary

A 59-year-old woman developed postoperative hypoxemia after elective retinal detachment repair under moderate sedation. She had a history of pulmonary embolism and breast cancer, and reported two weeks of dyspnea on exertion with productive cough. Initial evaluation was unrevealing: labs were normal, respiratory viral testing was negative, and exam showed bibasilar crackles without signs of volume overload. Imaging revealed diffuse bilateral ground-glass opacities, and bronchoalveolar lavage showed a neutrophil-predominant inflammatory pattern with negative infectious and cytologic studies.  <br /><br />Further history uncovered a key exposure: her daughter had adopted a parrot six months earlier. A Bird Fancier’s precipitin panel was positive for IgG antibodies to parakeet and parrot serum, supporting the diagnosis of hypersensitivity pneumonitis, specifically Bird Fancier’s lung. Additional potential exposures included work with automotive chemicals, but the bird exposure was the most relevant.  <br /><br />Hypersensitivity pneumonitis is caused by repeated inhalation of environmental antigens and can present with nonspecific respiratory symptoms, making diagnosis challenging. Bird Fancier’s lung is a common form associated with exposure to pet birds or feather-containing items. High-resolution CT and bronchoalveolar lavage can help support the diagnosis, but careful exposure history is essential.  <br /><br />The patient was treated with a prednisone taper and improved rapidly in oxygenation after pulmonary consultation and bronchoscopy. The case highlights the importance of considering hypersensitivity pneumonitis in complex postoperative patients with unexplained hypoxemia and of obtaining a detailed environmental history to prevent progression to irreversible pulmonary fibrosis.

Asset Subtitle

Joshua D. Garcia

Meta Tag

Author List Jessica Fuller, Joshua D. Garcia

Category Clinical Vignettes

Concept Hypersensitivity Pneumonitis

Concept Antigen Avoidance

Concept Environmental Exposure History

Concept Idiopathic Pulmonary Fibrosis

Concept Bird Fanciers Lung

Distinguished Non-Finalist

Presenter Organization University of North Carolina

Presenting Author Joshua D. Garcia

Track Adult

Keywords

hypersensitivity pneumonitis

Bird Fancier’s lung

postoperative hypoxemia

ground-glass opacities

bronchoalveolar lavage

parrot exposure

pulmonary fibrosis

prednisone taper

dyspnea on exertion

environmental antigen exposure

Hypersensitivity Pneumonitis

Antigen Avoidance

Environmental Exposure History

Idiopathic Pulmonary Fibrosis

Bird Fanciers Lung