A 36-year-old woman comes to the clinic for evaluation of a 4-month history of nonproductive cough and exertional dyspnea. Her only other medical problem is frequent heartburn, for which she takes over-the-counter antacids. Temperature is 37.1 C (98.8 F), blood pressure is 126/74 mm Hg, pulse is 88/min, and respirations are 20/min. Examination shows bilateral crackles and normal heart sounds. The remainder of the examination is unremarkable. An x-ray of the chest shows bilateral reticulonodular densities with interstitial fibrosis. Microscopic examination of a lung biopsy specimen shows noncaseating granulomas in the interstitium. Which of the following is the most likely diagnosis?

Question

A 36-year-old woman comes to the clinic for evaluation of a 4-month history of nonproductive cough and exertional dyspnea.  Her only other medical problem is frequent heartburn, for which she takes over-the-counter antacids.  Temperature is 37.1 C (98.8 F), blood pressure is 126/74 mm Hg, pulse is 88/min, and respirations are 20/min.  Examination shows bilateral crackles and normal heart sounds.  The remainder of the examination is unremarkable. An x-ray of the chest shows bilateral reticulonodular densities with interstitial fibrosis. Microscopic examination of a lung biopsy specimen shows noncaseating granulomas in the interstitium.   Which of the following is the most likely diagnosis?

Quizplus · Accepted Answer

Eductional Objective: Hypersensitivity pneumonitis involves an exaggerated immunologic response to an inhaled antigen and can have an acute or chronic presentation.  Chronic disease presents with gradually progressive cough, dyspnea, fatigue, and weight loss, and lung biopsy reveals lymphocytic infiltrate, poorly formed noncaseating granulomas, and septal fibrosis.

A 36-Year-Old Woman Comes to the Clinic for Evaluation of a 4-Month