Clinical radiological and pathological staging of children with hypersensitivity pneumonitis

Abstract

Objective: Hypersensitivity pneumonitis (HP) is rare in the pediatric population. To date, there are no studies defining a correlation between clinical, radiological, and pathological findings in children with HP. The objective of this study is to define the clinical, and radiological characteristics and prognosis of childhood HP and to examine the clinical, radiological, and pathological correlation between HP stages.Methods: Patients with suspected HP and followed at two tertiary care hospitals between 2000 and 2020 were retrospectively evaluated. Computed tomography (CT) of the chest of patients was evaluated by a single radiologist. The interagreement between clinical and radiological severity of the patients was calculated with the κ test.Results: Fourteen children with suspected HP were identified. The results of 10 patients with the definitive diagnosis were as follows: one patient (10%) had acute, five patients (50%) had subacute, and four patients (40%) had chronic HP. The most prominent findings in chest CT were hilar, or hilar and subcarinal lymphadenopathy (80%), centrilobular nodules (60%), patchy or diffuse ground-glass opacities (50%), and cysts (50%). The interagreement between clinical and radiological severity of the patients was 100% (approximate significance: 0.003). The diagnosis of four patients with suspected HP who were unresponsive to standardized medical treatments or developed multisystem involvement was diagnosed with other diseases. One patient (10%) with definitive chronic HP died due to respiratory failure during follow up.Conclusion: Similar to adult HP, the prognosis is worse in children with existing fibrotic equivalents in chest CT. Patients who are not responding to standard medical treatments or develop multisystem involvement should be evaluated for other lung diseases.

Tic Cough in an Adolescent with Organic Brain Pathology—A Case Report and Literature Review

“…As the patient's condition remained unclear, she underwent several medical investigations, including thoracic X-ray and spirometry, as well as consultation of an otorhinolaryngologist which did not reveal any pathology. Nevertheless, these investigations were important to rule out inflammatory [14][15][16][17] and neoplastic [18][19][20] lung diseases; albeit such conditions (e.g., tuberculosis, hypersensitivity pneumonitis, sarcoidosis, pleuropulmonary blastoma) are rare in children, they still have to be considered in the differential diagnosis. Normal spirometry findings were helpful to further exclude bronchial asthma.…”

Imaging of pulmonary fibrosis in children: A review, with proposed diagnostic criteria

“…44 While hypersensitivity pneumonitis in children may be nonfibrotic, fibrotic hypersensitivity pneumonitis has also been described. 45 Therapeutic radiation may also give rise to fibrotic changes in the lungs of children. 46 Pulmonary fibrosis following COVID-19 infection has also been observed in the pediatric setting.…”

“…Exposure‐related ILD has been reported in children with a variety of exposures, including humidifier disinfectant 43 and e‐cigarettes 44 . While hypersensitivity pneumonitis in children may be nonfibrotic, fibrotic hypersensitivity pneumonitis has also been described 45 . Therapeutic radiation may also give rise to fibrotic changes in the lungs of children 46 .…”