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Hypersensitivity pneumonitis — ABIM Board MCQ

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HardPulmonary/Critical CareHypersensitivity pneumonitisABIM Board

A 58-year-old bird breeder has progressive cough and dyspnea. HRCT shows mosaic attenuation, air trapping and upper-lobe ground-glass change; avian-specific IgG is positive. Which interpretation is most accurate?

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Correct answer: D — Integrate exposure and HRCT findings to diagnose hypersensitivity pneumonitis

The best answer is “Integrate exposure and HRCT findings to diagnose hypersensitivity pneumonitis”. A credible antigen exposure plus a compatible HRCT pattern strongly supports hypersensitivity pneumonitis, with BAL lymphocytosis, histology and multidisciplinary discussion used when diagnostic confidence remains incomplete. Serum IgG documents exposure and sensitization but is not diagnostic alone. The air-trapping pattern and exposure argue against calling this idiopathic fibrosis or fungal infection.

Reference: 2020 ATS/JRS/ALAT Hypersensitivity Pneumonitis Diagnostic Guideline: https://pubmed.ncbi.nlm.nih.gov/32706311/