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A woman aged 45 years suffered from progressive unclassifiable interstitial lung disease (ILD) despite treatment with corticosteroids, intravenous cyclophosphamide and rituximab. Chest CT showed extensive bilateral ground glass with associated mosaic attenuation and air trapping on expiration, along with basal predominant fibrosis, volume loss and secondary bronchial dilatation (figure 1A). Examination of bronchoalveolar lavage cytology and transbronchial biopsies showed features consistent with acute neutrophilic inflammation. Thorough medical history and detailed clinical examination revealed no relevant factors other than the fact that her husband kept pigeons in the back garden. However, she never had contact with the birds or her husband’s clothing, and the birds were removed immediately after her ILD diagnosis. Autoimmune and extended myositis screening were negative, as were avian precipitants.
Due to rapid progression of the disease, she underwent bilateral lung transplantation 2 years after the initial ILD diagnosis (figure 1B). Her early post-transplant period was complicated by mild …
Contributors SB: collected the clinical data and wrote the manuscript. JM: provided the pathology images and critically revised the manuscript. WF, AJF and GM: critically revised the manuscript.
Funding Following authors are supported by a research fellowship, but received no specific funding for the current manuscript: SB is funded by the Paul Corris International Clinical Research Training Scholarship. AJF is funded in part by the National Institute for Health Research Blood and Transplant Research Unit (NIHR BTRU) in Organ Donation and Transplantation at the University of Cambridge in collaboration with Newcastle University and in partnership with NHS Blood and Transplant (NHSBT).
Disclaimer The views expressed are those of the author(s) and not necessarily those of the NIHR, the Department of Health and Social Care or NHSBT. This case was presented as a poster presentation at the European Society for Organ Transplantation Congress 2023.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.