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Chronic Summer-Type Hypersensitivity Pneumonitis Presenting as Anorexia and Weight Loss

  • Yasuhiro Kano
    Correspondence
    Requests for reprints should be addressed to Yasuhiro Kano, MD, Department of General Internal Medicine, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo 183-8524, Japan.
    Affiliations
    Department of General Internal Medicine, Tokyo Metropolitan Tama Medical Center, Japan
    Search for articles by this author
  • Yu Sato
    Affiliations
    Department of General Internal Medicine, Tokyo Metropolitan Tama Medical Center, Japan

    Department of Respiratory Medicine, Tokyo Metropolitan Tama Medical Center, Japan
    Search for articles by this author
Published:February 04, 2022DOI:https://doi.org/10.1016/j.amjmed.2022.01.034
      A 79-year-old female patient was referred to our outpatient clinic with a 2-year history of anorexia and weight loss. Four years ago, she began experiencing malaise only in the summer, which she ascribed to the effects of summer heat. Two years ago, she began experiencing constitutional symptoms, including fatigue, malaise, and anorexia throughout the year, leading to 14 kg of weight loss until the current presentation. She denied fever and night sweats, had no previous history of smoking or other illnesses, including allergies or medication. She lived in an old wooden house built 50 years ago. On examination, her vital signs, including oxygen saturation, were normal. Her body mass index was 13 kg/m2. Physical examination found only slight, bibasilar inspiratory crackles. Laboratory tests revealed mildly elevated inflammatory markers, including leukocytes 9.2 (normal 3.3-8.6) × 109/L, C-reactive protein level 1.67 (< 0.15) mg/dL, and erythrocyte sedimentation rate 49 (3-15) mm/h. The patient's chest x-ray was interpreted as being within normal limits. A malignancy was initially suspected, and a systemic diagnostic work-up was scheduled. However, between the first and second visits, she moved to her son's house because she was anxious about living alone, whereupon all her long-standing symptoms quickly resolved. Chest computed tomography revealed diffusely scattered ground-glass opacities (Figure A). On further questioning, she stated that she had mild dyspnea on exertion from a month ago but denied any other respiratory symptoms. Additional tests returned positive for anti-Trichosporon asahii antibody and elevated Krebs von den Lungen-6 at 2378 U/mL. Based on these findings and the clinical course, chronic summer-type hypersensitivity pneumonitis (SHP) was diagnosed. The patient decided to continue living with her son. Two months later, all her symptoms had resolved, and her body weight had increased by 7 kg. Chest computed tomography findings and Krebs von den Lungen-6 were also improved (Figure B).
      Figure
      Figure(A) Chest computed tomography at the initial presentation revealed diffusely scattered ground-glass opacities with a somewhat centrilobular concentration in all lung fields. (B) Resolved computed tomography findings 2 months after the patient changed residence.
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