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Recurrent Pulmonary Embolism and Hypersensitivity Pneumonitis Secondary to Aspergillus, in a Compost Plant Worker: Case Report and Review of Literature

  • Interstitial Lung Disease
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Abstract

Activation of blood coagulation pathways as a component of an allergic response has been studied in animal models. In patients with allergic diseases, clot qualities have been noted to be different in terms of denser fibrin clot with reduced plasmin-mediated clot lysis. Correlation between occupational hypersensitivity pneumonitis (HP) with thromboembolic events is scarce in the general patient population. We present a case of a 52-year-old man with recurrent venous thromboembolism with HP secondary to bioaerosol exposure in a compost plant. Biochemical evaluation found no evidence of underlying hypercoagulable state, with only remarkable findings of elevated levels of total serum immunoglobulin E and raised Aspergillus sp. IgG antibodies. The patient decided to change his working environment to one without exposure to compost or other fungal elements. His symptoms and pulmonary function tests gradually improved without any subsequent intervention. The patient chose against the advice of his care providers to discontinue warfarin anti-coagulation that had been recommended for lifelong duration after recurrent pulmonary thromboembolism. At a 4-year follow-up he has remained free of any further episodes of venous thromboembolic events without any anti-coagulation. Repeated imaging studies after cessation of exposure demonstrated clearance of multiple lung nodules and improvement in DLco.

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Authors and Affiliations

  1. Department of Medicine, Saint Vincent Hospital, 123 Summer Street, Worcester, MA, 01608, USA

    Amos Lal, Jamal Akhtar & Himmat Grewal

  2. Department of Radiology, Saint Vincent Hospital, 123 Summer Street, Worcester, MA, 01608, USA

    Soniya Pinto

  3. Division of Pulmonology and Critical Care Medicine, Reliant Medical Group, 123 Summer Street, Worcester, MA, 01608, USA

    Kevin Martin

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  1. Amos Lal
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  2. Jamal Akhtar
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  3. Soniya Pinto
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  4. Himmat Grewal
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  5. Kevin Martin
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Contributions

AL: Study design, manuscript draft, and critical review of manuscript. JA: Literature review, data collection, and critical review of manuscript. HG: Literature review, data collection, and critical review of manuscript. SP: Literature review, image selection, and critical review of manuscript, KM: Inception of idea, and critical review of manuscript.

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Correspondence to Amos Lal.

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Lal, A., Akhtar, J., Pinto, S. et al. Recurrent Pulmonary Embolism and Hypersensitivity Pneumonitis Secondary to Aspergillus, in a Compost Plant Worker: Case Report and Review of Literature. Lung 196, 553–560 (2018). https://doi.org/10.1007/s00408-018-0142-6

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  • DOI: https://doi.org/10.1007/s00408-018-0142-6

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