Concluded Case

Hypersensitivity pneumonitis

35 yrs male, Mine worker Patient came with complaints of Cough (Mostly Dry),DOE grade 2 mmrc, Low grade fever, Anorexia, Weakness since 1 Month. Spo2 94 % room air Covid RTPCR negative thrice. Possibilities ???

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Concluded answer

HSP panel was sent. Patient was diagnosed to be a case of sub acute Hypersensitive pneumonitis. Patient was put on MPS 32 mg. Patient improved with treatment . CT repeated after 10 days which Showed Normal study.

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Multiple cavitory lesions bilaterally emphysematous Fibrotic strands and thickening of fissures seen bilaterally D/d pneumoconiosis with fibrosis lung 2 tuberculosis 3 bronchiactasis

Thanx dr Pushkar ji Bhomia
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This patients HRCT chest is showing diffuse ground glass appearance involving entire of lung field This is atypical of Covid 19, as in Covid 19 the ground glass appearance is specifically limited to peripheral lung field and Central lung field of usually unaffected Considering this patient is mine worker, this case could easily fit in to diagnosis of interstitial lung disease, as a part of occupational hazard.

The HRCT shows B/l reticulation, ground-glass opacification&nodularity.Most probable Differential considering occupation could be diffuse interstitial lung disease: ? Silicosis, ? Asbestosis etc. Another possibility is Sarcoidosis, lymphocytic interstitial pneumonia etc. Routine tests maybe initially sent but mostly it would be of limited value.Maybe serological tests like rheumatoid factor,ESR,CRP,anticitrulline antibody,ACE etc could provide a clue. A Pulmonary function test should definitely be done along with sputum for AFB/CBNAAT. Rx wise may I suggest: 1.corticosteroids as per need 2.Nebulisation with Budecort BD and Duolin TDS 3.Nintib(Nintedanib) 150mg BD 4.Syp.Ascoril D TDS 5.Other supportive measures including supplemental O2,hydration&antipyretics

Pneumoconiosis B/L lungs nodular infiltration Ad CBNAAT Sputum exam

Subtle ggos bilateral lung parenchyma corads 2 CT severty 0

Consider ICS LABA LAMA combination Antifibrotics. Adv Echo CD to rule out PAH.

HSP panel was sent. Patient was diagnosed to be a case of sub acute Hypersensitive pneumonitis. Patient was put on MPS 32 mg. Patient improved with treatment . CT repeated after 10 days which Showed Normal study.

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