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Respiratory medicine
Hypersensitivity pneumonitis secondary to foam exposure in mattress and pillows
  1. Maria Alejandra Coppola Lamas1,2,
  2. Alexander Boag2,3,
  3. Dominique Dabreo2,4 and
  4. Onofre Moran-Mendoza1,2
  1. 1Division of Respirology, Queen's University, Kingston, Ontario, Canada
  2. 2Kingston Health Sciences Centre, Kingston, Ontario, Canada
  3. 3Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada
  4. 4Department of Diagnostic Radiology, Queen's University, Kingston, Ontario, Canada
  1. Correspondence to Dr Onofre Moran-Mendoza; morano{at}queensu.ca

Abstract

Fibrotic hypersensitivity pneumonitis (HP) has a poor prognosis when no antigen is identified, which occurs in many cases. We present a case of HP due to foam exposure in bedding, an unrecognised cause of HP. A woman was referred for dyspnoea and cough. High-resolution chest computed tomography (HRCT) showed a three-density pattern with gas trapping. Pulmonary function tests (PFTs) revealed restriction and reduced diffusing capacity. Bronchoalveolar lavage showed lymphocytosis (43%) and lung cryobiopsy showed fibrosis, lymphocytic infiltration and multinucleated giant cells. She had foam in mattress and pillows but no other exposures. Her symptoms, PFTs, and imaging improved after avoiding foam in her bedding. After re-exposure to a foam pillow, her symptoms, PFTs, and HRCT worsened. Microbiological analysis of the foam pillow reported Penicillium spp, known to cause HP. Foam exposure is a novel cause of HP, and foam avoidance can prevent disease progression and death.

  • Interstitial lung disease
  • Exposures

https://doi.org/10.1136/bcr-2024-260517

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    Footnotes

    • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinicalimages, investigation results, drawing original diagrams and algorithms, and critical revision forimportant intellectual content: OM-M, MACL, AB, DD. The following authors gave final approval of the manuscript: OM-M, MACL, AB, DD.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.