CTICasesHypersensitivity Pneumonitis (from Down Comforter)
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Imaging findings
Reticulation, mosaic consolidation in the upper lobes, and a background mosaic pattern. Traction bronchiectasis in the lower lobes. Significant ground glass with a peribronchovascular distribution. Expiratory CT showed mosaic attenuation and air trapping in three lobes (both upper lobes and superior segments of lower lobes).
Key takeaways
Several features (upper lobe involvement, ground glass, peribronchovascular distribution, mosaic pattern with air trapping) made this inconsistent with UIP, fitting well with hypersensitivity pneumonitis (HP). Initial misdiagnosis as organizing pneumonia, but lack of steroid response prompted biopsy. Biopsy confirmed non-necrotizing granulomas consistent with HP. An extensive questionnaire identified a new down comforter as the likely antigen inciting the HP, showing that HP panels are not always necessary with good clinical history.
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