AM Report Pearls: Hypersensitivity Pneumonitis

  • Hypersensitivity pneumonitis (HP) is also called extrinsic allergic alveolitis – chronic granulomatous inflammation in response to repeated inhalation of environmental antigens
  • Take a detailed occupational/exposure history – birds, pets, hot tub, saunas, mold, down comforters, etc.
  • Three main timecourses/forms that you see:
    • Acute: Occurs after intermittent heavy exposure to antigen – you can have fevers, chills, malaise, dyspnea, chest tightness & cough ~4-8 hrs post-exposure, can resolve within 48 hrs
    • Subacute: Episodic attacks/flares that resemble acute HP with chronic low-level antigen exposure
    • Chronic: Often no history of acute episodes, chronic progressive dyspnea, cough, fatigue over months
  • High-res Chest CT can show a variety of findings that can mimic IPF – GGOs, mosaic perfusion with air-trapping, diffuse reticular opacities, micronodules, loss of lung volume, honeycombing
  • Refer to a certified industrial hygienist to help go into the patient’s home to remove offending antigen
  • Great 2-page review of HP by UCSF faculty here:

AM Report Pearls: Arrhythmogenic Right Ventricular Dysplasia 

  • ARVD is a hereditary condition w progressive fibrofatty replacement of cardiac myocytes in the RV>LV. Prevalence is 1:1000-5000 in the general pop. but up to 25% in cases of sudden cardiac death < 30yo
  • Presentation – age teens-30s w/ palpitations, syncope, lightheadedness, ventricular arrhythmias or sudden cardiac death. Symptoms may precede apparent structural disease. 
  • Diagnosis – based on having 2 major, 1 major + 2 minor, or 4 minor Task Force Criteria. See attached article for criteria details. Can also test for known genetic mutations.
  • Treatment – ICD placement in pts with VT/VF, high PVC burden, or symptoms of ARVD.

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