CTICasesChronic Hypersensitivity Pneumonitis from Occupational Penicillium Exposure
Imaging findings
A patient with several years of chronic lung disease who worked at a corrugated cardboard manufacturing plant had CT showing predominantly upper-lung, peribronchial ground-glass and reticular opacity that extended somewhat into the periphery in the lower lobes but remained centered on the bronchovascular bundles rather than the pleura. Symptoms worsened on return to the workplace and improved when away from work; testing showed sensitivity to a Penicillium species, and biopsy showed peribronchiolar fibrosis consistent with chronic hypersensitivity pneumonitis.
Key takeaways
A peribronchial, upper-lung-predominant pattern of ground-glass and fibrotic opacity that correlates temporally with workplace presence and improves with time away from work is a strong clue to chronic hypersensitivity pneumonitis. Fungal contamination of organic materials such as cardboard or wood pulp, in this case a Penicillium species, is a recognized but under-recognized occupational trigger, analogous to entities like wood pulp workers' lung.
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