Occupational Asthma Reference
King J, Richardson M, Quinn A, Holme J, Chaudhuri N,
Bagpipe lung; a new type of interstitial lung disease?,
Keywords: HP, EAA, UK, bagpipe, musician, fungae, rhodotorula, penicillium, fusarium, trichosporon,case report, death
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. 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.
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This is an interesting case report of fatal HP in a bagpipe player, whose bagpipes yielded Penicillium species, Fusarium oxysporum, Rhodotorula mucilaginosa and Trichosporon mucoides. The diagnosis was made from a history of improvement while away from home and bagpipes for 3 months in Australia, and deterioration on return. There was no physiological confirmation of these changes or search for precipitating antibodies, which would have helped confirm the causal relationship between the bagpipes and the HP.
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