CTICasesChronic Hypersensitivity Pneumonitis
Imaging findings
High-resolution CT shows diffuse, central-lobular smudgy ground-glass nodules and patchy ground-glass opacity, which had been previously misdiagnosed as miliary coccidioidomycosis due to positive serology. The findings resolved/improved after removing the patient from environmental exposures and initiating corticosteroids.
Key takeaways
Anchoring bias on a single positive serologic test (e.g. coccidioidomycosis) can lead to diagnostic errors. Smudgy, poorly defined centrilobular ground-glass nodules are classic for subacute/chronic hypersensitivity pneumonitis (HP) rather than well-defined miliary fungal nodules.
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