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While rare in the pediatric population, with an estimated prevalence of 4 cases per million children,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> common triggers in children include bird antigens, fungal aerosols, and certain drugs. HP manifests as acute, sub-acute, or chronic forms, diagnosed based on (1) documented antigen exposure, (2) compatible respiratory symptoms, (3) decreased carbon monoxide transfer factor or exertional hypoxia, (4) specific radiologic features, and (5) lymphocytic alveolitis.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> Treatment involves antigen avoidance and occasionally corticosteroids. Here, we present a case of a 5-year-old girl diagnosed with HP due to exposure to turtledove droppings.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 5-year-old girl was referred to our tertiary hospital for “recurrent asthma attack” with hypoxemia requiring three hospitalizations in one month. She had no prior history of asthma or atopy, either personally or in her family. She had experienced dyspnea and a dry cough for two months, accompanied by fever for one day at symptom onset and anorexia. On admission, she had tachypnea (57/min) with saturation at 88% in room air, needing supplemental oxygen. Chest auscultation was normal. Chest X-ray showed fine reticulation and diffuse opacities. A detailed environmental history revealed prolonged exposure to domestic turtledove (6 months), with excreta all over the apartment. Her respiratory signs were improved during hospitalization with steroid treatment but worsened upon each discharged at home. CT scan showed diffuse centro-lobular ground glass opacities (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Broncho-alveolar lavage (BAL) confirmed lymphocytic alveolitis with 1500<span class="elsevierStyleHsp" style=""></span>cells/mm<span class="elsevierStyleSup">3</span> including 30% lymphocytes (normal range: <10%). The CD4/CD8 ratio was reversed (0.6; normal range: 0.9–2.5). Serum precipitin tests were positive for avian serum (IgG pigeon 91<span class="elsevierStyleHsp" style=""></span>mgA/L, IgG chicken 32<span class="elsevierStyleHsp" style=""></span>mgA/L; normal range<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>30, FEIA method), corroborated by the presence of specific arch (bird fancier's). Other causes of interstitial lung disease were ruled out through BAL studies, immunological assessments, and infectious disease screenings.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The patient was treated with 24<span class="elsevierStyleHsp" style=""></span>h of oxygen and oral prednisone at 1<span class="elsevierStyleHsp" style=""></span>mg/kg/day with tapering for a total of 3 months. Upon discharge with avoidance advice, the patient showed excellent evolution during follow-up. Her apartment was cleaned, and the bird was removed. After three months of steroid treatment, she had no more dyspnea, oxygen pulse oximetry was 99%, and she gained weight. Lung volume and DLCO was not possible because of her age.</p><p id="par0020" class="elsevierStylePara elsevierViewall">HP is often underrecognized by pediatricians, leading to delayed diagnosis averaging between 1 and 11 months,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> with the risk of irreversible pulmonary fibrosis. Clinical recognition relies on exposure history and respiratory findings. Predominant pediatric triggers include bird or fungal antigens.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Our case highlights HP in a 5-year-old exposed to domestic turtledove droppings, with only one similar case reported.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> Despite pigeons being more commonly cited, the allergens are common to both species, as they belong to the same taxonomic family, Columbidae.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> This case underlines the importance of environmental exposure interrogation in front of interstitial lung disease, for accurate diagnosis and treatment.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0025" class="elsevierStylePara elsevierViewall">This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors’ contributions</span><p id="par0030" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0035" class="elsevierStylePara elsevierViewall">Maggiolino Quentin: Conception and writing of the article. Bibliography collection.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0040" class="elsevierStylePara elsevierViewall">Socchi Floriane: Critical revision of the article.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0045" class="elsevierStylePara elsevierViewall">Renoux Marie-Catherine: Final approval of the article.</p></li></ul></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors declare not to have any conflicts of interest that may be considered to influence directly or indirectly the content of the manuscript.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Artificial intelligence involvement</span><p id="par0055" class="elsevierStylePara elsevierViewall">No material in this manuscript has been produced with the help of any artificial intelligence software or tool.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Authors’ contributions" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Artificial intelligence involvement" ] 4 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 394 "Ancho" => 1000 "Tamanyo" => 59910 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">HRCT showing bilateral diffuse centro-lobular ground glass opacities.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Frequency, treatment, and functional outcome in children with hypersensitivity pneumonitis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F. 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Journal Information
Vol. 60. Issue 10.
Pages 656-657 (October 2024)
Vol. 60. Issue 10.
Pages 656-657 (October 2024)
Clinical Letter
Hypersensitivity Pneumonitis in a 5-Year-Old Girl due to Turtledove: A Case Report
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Maggiolino Quentin
, Renoux Marie-Catherine, Socchi Floriane
Corresponding author
Department of Pediatric Pulmonology, Montpellier University Hospital, Montpellier, France
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