A case of hypersensitivity pneumonitis related to sericulture (sericulturist's lung disease).

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  • 「蚕（カイコ）」体成分の吸入に起因する過敏性肺炎（養蚕者肺症）の１例

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Abstract

A 48 year-old woman, engaged in sericulture (silk production) for more than 20 years, was admitted to our hospital because of cough, sputum and exertional dyspnea. She developed these symptoms in the evening after sericultural work. She also had slight fever and had lost weight. On admission, physical examination revealed fine crackles in the bilateral lower lung fields. Laboratory examination revealed elevated ESR, positive CRP, leukocytosis and elevated LDH levels. Chest X-ray showed diffuse fine nodular infiltrates in both lungs. Pulmonary function tests disclosed decrease of vital capacity and of carbon monoxide diffusing capacity. Arterial hypoxemia at rest was also seen.<br>Immunological examination revealed elevation of serum IgA levels and negative conversion of skin reactivity to PPD. Serum precipitating antibody against ripe larva urine, an antigen extracted from the body constituents of silk-worms, was detected.<br>Histological examination of lung tissues obtained through transbronchial lung biopsy revealed granulomatous interstitial pneumonia with Masson bodies.<br>Inhalation test with the ripe larva urine did not reproduce the clinical symptoms of the disorder. However, 6 hours after inhalation, fine crackles reappeared and a drop in diffusion capacity was observed.<br>The diagnosis of hypersensitivity pneumonitis due to ripe larva urine was made on the basis of these results.<br>From the above findings, we would like to propose that silkworm antigens should be added to the list of causes of hypersensitivity pneumonitis.

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