An onion farmer with a case of hypersensitivity pneumonitis caused by Aspergillus niger

Abstract

A 62-year old man was admitted to our hospital with a 2-week complaint of a dry cough, general fatigue, and dyspnea on effort. He has been an onion farmer for several years and developed these symptoms after cleaning up onion peels with air compressors. A chest roentgenogram and computed tomography showed a ground glass shadow in the bilateral upper lung field. Cellular analysis of the bronchoalveolar lavage fluid showed elevated total cell numbers and lymphocytes. Transbronchial lung biopsies revealed a non-caseating granuloma with both epithelioid cells and Langhans giant cells. After the admission, these symptoms and radiological findings gradually improved without any treatment. Then, a returning-home provocation test was positive only when he worked cleaning up onion peels with air compressors. A. niger was cultured from his workplace and black mold from the onion peels. The precipitation antibody and the antigen were both positive for Aspergillus. Therefore, we diagnosed this case as hypersensitivity pneumonitis caused by inhalation of A. niger.Although hypersensitivity pneumonia caused by A. niger is rare, physicians should aware the possibility of this condition in farmers because A niger is ubiquitously present in several vegetables and fruits.

The association between fungi exposure and hypersensitivity pneumonitis: a systematic review

“…Another case of HP was reported in a 62-year old onion farmer who had dry cough, general fatigue, and dyspnea on effort. 36 After ceasing exposure to the onions, his clinical symptoms gradually improved in a week without any treatment. The results of immunological tests for Aspergillus was positive.…”

Antifungal Resistance in Isolates of Aspergillus from a Pig Farm

“…The presence of multidrug-resistant A. niger should be of concern, as although invasive disease caused by A. niger is less commonly described, it is a known human pathogen, and can cause invasive aspergillosis [21,34]. In addition, inhalation of spores from A. niger has been known to induce hypersensitivity pneumonitis [35], and the spores from A. niger have been shown to be cytotoxic [36].…”

Fungi in a One Health Perspective

“…Some pulmonary pathologies are related to occupational exposure to Aspergillus conidia that cause Aspergillus-induced allergic and asthmatic lung diseases [68]. An example of occupational disease caused by Aspergillus is an onion farmer that developed hypersensitive pneumonitis caused by the inhalation of A. niger while cleaning up onion peels with air compressors [70]. Aspergillus genus is divided in several sections, of which the Fumigati, Circumdati, Terrei, Nidulantes, Ornati, Warcupi, Candidi, Restricti, Usti, and Flavipedes sections contain relevant species in clinics [10].…”