Bagpipe Lung: A Fatal Case Of Hypersensitivity Pneumonitis

luke-curtis
Hypersensitivity pneumonitis (HP) is a form of inflammatory lung disease mediated by inhaled allergen(s) and can progress to disabling or fatal lung disease. A number of different types of mold (fungi) and bacteria can trigger HP- as can exposure to birds, dusty food items such as flour and other types of dust. 


A case study was presented of a
61 year old man with a 7-year history of dry cough and breathlessness. His walking tolerance declined from more than 10 kilometers to only 20 meters during these 7 years. The patient was a life-long non-smoker, without any obvious exposures to birds, pesticides, second hand tobacco / wood smoke, or visible mold. He played the bagpipes daily as a hobby. He suffered a severe decline in lung capacity- with a forced vital capacity (FVC) of only 1.48 liters- only 34% of expected. Lung biopsy showed interstitial fibrosis and poorly formed granulomas. He was admitted to hospital with shortness of breath at age 61. In spite of intense hospital treatment including oxygen therapy and antibiotics, he died a month later.

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Samples from the bagpipes revealed large number of molds (fungi) including Paecilomyces variotti, Fusarium oxysporum, Penicillium species, Rhodotorula mucilaginosa, Trichosporon, pink yeast, and Exophilia dermatidi. Earlier case studies were reported of musicians developing hypersensitivity pneumonitis after playing a saxophone and trombone contaminated with mold. Fortunately, these 2 cases recovered after cleaning the instruments with detergent or 91% isopropyl alcohol. Keeping wind instruments clean and dry is critical for preventing growth of mold and bacteria on wind instruments.

 

References / Sources

King, J., Richardson, M., Quinn, A. M., Holme, J., & Chaudhuri, N. (2016). Bagpipe lung; a new type of interstitial lung disease? Thorax. doi:10.1136/thoraxjnl-2016-208751


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