Asian Journal of Case Reports in Medicine and Health

Background: The severity and length of exposure determine hypersensitivity pneumonitis (HP) clinical presentation, as symptoms can vary from acute flu-like symptoms to chronic fibrotic lung disease. Inhaling organic or chemical antigens can cause HP, which is an inflammatory lung condition.

Aims: Here we present a rare case of hypersensitivity pneumonitis that presented with spontaneous pneumomediastinum and pneumopericardium.

Place and Duration of Study: This case study was carried out at Department of Internal medicine and Pulmonology in Kuwait hospital, Sharjah, United Arab Emirates.

Case Presentation: A 54-year-old man with no pre-existing illness presented with subacute worsening shortness of breath over 3 weeks, associated with cough, fever and sweating. There was history of recent occupational wood dust exposure. Clinical, radiological and bronchoscopy features were suggestive of hypersensitivity pneumonitis with spontaneous pneumomediastinum and pneumopericardium. Patient responded well with corticosteroids with complete recovery.

Discussion: Pneumomediastinum is a rare complication seen in interstitial lung disease patients alone or associated with pneumothorax. The importance of parenchymal remodelling in HP has been highlighted by recent research, which may increase the risk of barotrauma by altering lung mechanics. Those with a violent cough or honeycombing are especially predisposed. Areas of air trapping and regional pressure variations may lead to alveolar rupture and could be identified with the use of sophisticated imaging techniques, such as inspiratory and expiratory CT scans.

Conclusion: Hypersensitivity pneumonitis can be frequently mistaken for other infective conditions. Emphasis needs to be given on detailed occupational history taking. Spontaneous pneumomediastinum and pneumopericardium can be rare presenting symptoms of hypersensitivity pneumonitis.