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Case based discussions
Bagpipe lung; a new type of interstitial lung disease?
  1. Jenny King,
  2. Malcolm Richardson,
  3. Anne-Marie Quinn,
  4. Jayne Holme,
  5. Nazia Chaudhuri
  1. UHSM, Wythenshawe, UK
  1. Correspondence to Dr Jenny King, UHSM, Southmoor Road, Wythenshawe M239LT, UK; j.king{at}doctors.org.uk

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Background

Hypersensitivity pneumonitis (HP) is an inflammatory lung disease mediated by an immunological response to an inhaled antigen and can progress to disabling or fatal lung disease. It is related to occupational or other environmental exposures. In a significant proportion of patients, the antigen is often difficult to identify from the clinical history.1 This case highlights the importance of a careful clinical history including hobbies, because in this case, playing the bagpipes, we feel, was very relevant to the development of HP. We were able to isolate various fungal species from the bagpipes. There have been isolated case reports of musicians developing HP.2 ,3 Clinicians need to be aware of this potential trigger for developing HP, and wind instrument players need to be aware of the importance of regularly cleaning their instruments to minimise this risk.

Case presentation

A 61-year-old man was referred to the interstitial lung disease (ILD) clinic in April 2014 with a 7-year history of dry cough and progressive breathlessness despite immunosuppressive therapy, leading to a reduction in exercise tolerance from over 10 kilometres to 20 metres. He had a prior diagnosis since 2009 of HP based on high-resolution CT (HRCT) and biopsy findings from his referring hospital. He did not have any exposure to birds or pigeons. His house showed no evidence of mould or water damage, and he had no symptoms of connective tissue disease. The precipitating trigger for his HP was unknown. His symptoms were insidious and progressive, with the exception of a 3-month period in 2011 when he went to live in Australia. He reported that during this time his symptoms rapidly improved and that he was able to walk 10 kilometres on the beach without stopping. On returning to the UK, his breathing deteriorated rapidly. There was no significant medical history. He …

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