Hypersensitivity pneumonitis induced by Penicillium expansum in a home environment

Abstract

An episode of fever, cough, shortness of breath and leucocytosis developed in a 31-year-old atopic housewife from mould exposure in her home environment is evaluated. A chest radiograph revealed diffuse tiny nodular infiltrations in both whole lung fields. Spirometry revealed a severe restrictive type of ventilation impairment. Bronchoalveolar lavage (BAL) showed an increased lymphocyte count with reversed CD4+/CD8+ ratio and transbronchial lung biopsy showed markedly increased lymphocytic infiltration in alveolar septa. Fungal cultures in the air of her home were positive for Penicillium expansum and other fungi. Double immunodiffusion test with the patient's serum showed two precipitin bands to P. expansum antigens. Her symptoms, abnormal findings of radiograph, and spirometric abnormalities disappeared after 2 months' avoidance. The serum precipitin disappeared after 1 month's avoidance. This study indicates that the patient had hypersensitivity pneumonitis (HP) on exposure to P. expansum in her home environment.

Bronchoalveolar Lavage Findings from Persons Exposed to Moulds in Water-Damaged Houses

“…In BAL fluid from a 31-year old atopic housewife exposed to Penicillium expansum, Park et al [4] found an increased lymphocyte count with reversed CD4 þ /CD8 þ ratio, supporting the findings of our study.…”

“…There are a few case reports in the literature of persons exposed to moulds in their home environment with diagnosed hypersensitivity pneumonitis [3,4]. In BAL fluid from a 31-year old atopic housewife exposed to Penicillium expansum, Park et al [4] found an increased lymphocyte count with reversed CD4 þ /CD8 þ ratio, supporting the findings of our study.…”

Health effects of indoor-air microorganisms

“…In indoor-air exposure, only sporadic cases of alveolitis have been reported in Finland (71). In other countries, a few cases of alveolitis caused by Penicilliunz species have been reported, along with sporadic cases caused by yeasts, such as Spovobolomyces and Rhodotorula (72)(73)(74). In some cases, the findings have not met all the classical diagnostic criteria of alveolitis.…”

Toxic and other non-IgE-mediated effects of fungal exposures

“…Reports of acute mold-related HP include children exposed to an unventilated shower contaminated with Epicoccum nigrum [2], a housewife exposed to Penicillium expansum contaminated wood dust [3], the inhalation of basidiospores during processing and packing of mushrooms [4], and an adult who developed HP caused by Pezizia domiciliana after house flooding from the rains of El Niño [5]. Species of Aspergillus have been implicated in a soy sauce brewer, a farmer with a poorly ventilated greenhouse, a hospitalized patient inhaling contaminated humidified oxygen [6], and Spanish stucco makers working with moldy esparto grass fibers [7].…”