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Hypersensitivity pneumonitis — RACP Paediatrics MCQ

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ModerateRespiratoryHypersensitivity pneumonitisRACP Paediatrics

A 12-year-old who keeps pigeons develops progressive breathlessness, cough, and fever over weeks. HRCT shows diffuse ground-glass opacities with centrilobular nodules. Serum precipitins to avian proteins are positive. Symptoms improve when away from home. What is the most likely diagnosis?

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Correct answer: D — Hypersensitivity pneumonitis

Recurrent respiratory symptoms with environmental exposure (birds/pigeons), positive serum precipitins, and characteristic HRCT findings (ground-glass, centrilobular nodules) that improve with avoidance of exposure is hypersensitivity pneumonitis (extrinsic allergic alveolitis). Bird fancier's lung is the most common type in children. Complete allergen avoidance is the primary treatment.

Reference: RACP Paediatric Curriculum – Respiratory; Australian Therapeutic Guidelines – 2024