C58-12 Stay Away From Chickens: Bird Fancier’s Lung

Introduction Hypersensitivity pneumonitis (HP) is an interstitial lung disease characterized by diffuse inflammation of the lung parenchyma and airways due to an immunological reaction to repetitive sensitized allergen. Bird Fancier’s Lung (BFL) is a type of HP triggered by air-borne avian antigens such as bird feathers, skin, or guano. We present a case of BFL in a patient who raised chickens his whole life. Case Presentation A 58 year old male with no significant past medical history presents with chronic fatigue and dyspnea. He was diagnosed with COVID-19 about a year ago and since then, he became weaker. He endorsed chronic cough, fatigue, 30 lb weight loss, and dyspnea within the past year. Further evaluation revealed that the patient raised chickens his whole life. CT chest showed patchy areas of groundglass throughout the lungs with areas of intralobular septal thickening. The patient was suspected to have BFL and was advised to remove the offending agent, chickens, from his home. The patient symptomatically improved. A repeat CT chest done 2 months later with slightly improved aeration of the lungs, but there were still persistent groundglass opacities which was worse in the mid and lower lungs. The patient was started on long-term glucocorticoid treatment. A repeat CT chest was done 3 months later that now showed mildly increased areas of patchy groundglass and few small areas of peripheral reticulation with architectural distortion likely reflecting scarring with traction bronchiolectasis. The patient was referred to thoracic surgery for definitive diagnosis of HP. Video-assisted thoracic surgery was performed. The patient had lysis of adhesions and left minithoracotomy with wedge resection of the upper and lower lobe. Wedge biopsies were consistent with HP. He remained on long-term glucocorticoid treatment. Repeat CT chest was done 4 months later with improved aeration on the bilateral lungs with decreased groundglass opacities. Discussion Our patient presented with HP, specifically BFL. He was initially treated with removal of the offending agent. Despite this, he continued to worsen and was started on long-term glucocorticoid therapy. He still worsened, so a biopsy was done to confirm the diagnosis. He remained on long-term glucocorticoid therapy with improvement of his groundglass opacities. It is important to gather a thorough history in individuals suspected of having HP. Removal of exposure to the offending antigen is crucial in the treatment of HP. When in doubt, a biopsy can confirm the diagnosis with appropriate continuation of the medication. This abstract is funded by: None