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Fibrotic hypersensitivity pneumonitis — SCE Respiratory MCQ

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ModerateInterstitial lung diseaseFibrotic hypersensitivity pneumonitisSCE Respiratory

A 58-year-old man has progressive dyspnoea and dry cough. HRCT shows upper-lobe predominant fibrosis, mosaic attenuation and air trapping on expiratory images. Serum precipitins to avian antigens are positive and he keeps racing pigeons in an indoor loft. Bronchoalveolar lavage shows lymphocytosis. What is the most likely diagnosis?

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Correct answer: D — Chronic hypersensitivity pneumonitis

The best answer is “Chronic hypersensitivity pneumonitis”. The clinical pattern, physiology and imaging described are most consistent with Chronic hypersensitivity pneumonitis. The competing diagnoses may share individual findings, but do not account for the complete combination in the stem. The remaining choices—“Idiopathic pulmonary fibrosis”, “Coal worker pneumoconiosis”, “Chronic eosinophilic pneumonia”, “Diffuse pulmonary haemorrhage”—are credible in related respiratory presentations, but each addresses a different diagnostic, staging or management decision and does not fit the decisive findings and pathway position in this stem.

Reference: ATS/JRS/ALAT hypersensitivity pneumonitis diagnostic guideline: https://pmc.ncbi.nlm.nih.gov/articles/PMC7397797/