Bird fancier's lung presenting as hypersensitivity pneumonitis with inflammatory features — ground glass opacities on HRCT, bronchoalveolar lavage lymphocytosis, or acute/sub-acute symptom onset — with no pulmonary fibrosis on imaging or histopathology.
A steroid-sparing immunosuppressive agent (mycophenolate mofetil, azathioprine, methotrexate, or cyclophosphamide) was added to allow corticosteroid weaning. The required goals — improvement in clinical parameters or disease stabilisation with maintenance of lung function (FVC, DLCO) — were not achieved, indicating the need to escalate.
The next step involves a third-line immunosuppressive strategy using a biologic agent. The complete regimen and monitoring plan are detailed in the full protocol.
DOI: 10.1111/resp.14847
Moderate-to-high dose systemic corticosteroids would usually be considered for HP patients with features of inflammation (e.g., GGO on HRCT, BAL lymphocytosis, well-documented exposure with acute or sub-acute symptom onset).
Recently published international diagnostic guidelines recommend HP classification into fibrotic or nonfibrotic phenotypes based on the presence or absence of radiological and/or histopathological fibrosis, supported by the observation that pulmonary fibrosis conveys important prognostic and treatment implications.
There is case series-level evidence only for third-line agents including rituximab in HP.
View source ↗