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(CNN) - Symptoms advanced rapidly. First, it was difficult to breathe, then the dizziness caused with minimal effort arrived.
"Two months after the onset of symptoms, I was not able to stand or walk for more than a few minutes, without feeling like I was going to pass out," wrote Martin Taylor, a 43-year-old man from Aberdeenshire, Scotland, in a case study published Monday in the BMJ magazine.
"Climbing the stairs to go to bed was an activity that took me 30 minutes, since I could only climb two stairs at a time and then I needed to sit down and rest," Taylor added.
Martin Taylor of Aberdeenshire, Scotland.
Four appointments the doctor failed in an attempt to find the cause, which was "extremely distressing," wrote Taylor, who had never smoked. When his health failed, he stayed at home and spent most of his days and nights asleep.
Taylor did not know at the time that he was suffering from hypersensitivity pneumonitis, a disease in which the lungs become inflamed as a result of an allergic reaction. When detected at an early stage, the disease can be easily treated. If it is not diagnosed, it can cause permanent scarring in the lungs and can even cause death.
Unfortunately, in the case of Taylor, the first doctors who saw him had no idea of the cause.
Playing to be Dr. Sherlock
Initially, Taylor was treated for an upper respiratory infection. But, his health continued in decline for the next three months. Then, the radiologist ruled out a chest x-ray of his lungs as usual.
Concerned, his GP called the respiratory clinic urgently and spoke with Dr. Owen John Dempsey, a chest specialist at Albyn BMI Hospital in Aberdeen, Scotland, located about 30 minutes by car from Aberdeenshire.
"His general practitioner was very clever in not accepting the results of the chest x-ray," said Dempsey, adding that it can be difficult to diagnose hypersensitivity pneumonitis because the changes are often subtle with a "mild gray diffuse in the lungs ”.
"I think the radiologist thought it was just a slightly 'underexposed' chest x-ray," said Dempsey.
Dempsey picked up the phone and called Taylor.
"He seemed to be out of breath after just walking from one room in his house to the other," Dempsey said. “Very abnormal for such a young man. It was clear that the patient had a progressive and very disabling respiratory distress, which this time interfered with his activities of daily living. ”
Making the diagnosis was "almost a bit like a puzzle," Dempsey said. One of the first clues was Taylor's blood test, which showed that his immune system was exposed to avian protein. However, Taylor told Dempsey that he had no birds, only a cat and a dog.
"I have a particular interest in this group of diseases," Dempsey said. "And we know that if you take a meticulous history, you can often identify triggers of lung diseases in the environment."
Demsey went deeper: Taylor lived in a warm and dry house with his wife. They had a loft, which they hardly visited much, but they did have a bathroom, which connected to their room, with a little mold on the shower and the window. He had not traveled abroad. He had no history of drugs. I worked in an office that had no obvious exposures. And he played guitar and saxophone in a local band.
"We get paid for being gossipy," Dempsey said. “The danger is that we don't ask enough and assume that the diseases are 'idiopathic' or inexplicable. If so, we lose the trick and our patients are subject to unnecessary tests or treatments. ”
Finally, Dempsey's questions touched the floor: the couple had recently replaced the synthetic bed cover of their bed with a down comforter and feather pillows. Taylor had a lung disease from his down comforter.
As Sherlock would say, "Elementary, my dear Watson."
Feather quilt lung disease
Bird allergies are not uncommon. Often called asthma of bird breeders, their symptoms can range from a gasping cough, runny nose and eye irritation, to asthma and more serious complications such as Taylor's. People with allergies are at greater risk when cleaning bird cages, or haystacks, and during the time of the year when birds change feathers.
Lung disease caused by feather quilts is a subset of asthma of bird breeders, and it is difficult to diagnose due to its rarity and its wide variety of time and type of symptoms.
The onset of symptoms after exposure to new comforters or feather pillows can vary from three weeks to five years. Difficulty breathing may increase over time, and the patient may have episodes of sweating at night, dry cough, weight loss and fever. This condition is often misdiagnosed if the person says they have no birds in their home, and many doctors do not think about asking for bedspreads.
"Most doctors, in my experience, don't ask that level of detail," said Dempsey, adding that doctors should always ask about other exhibitions at home, including bed, mold, warmth and dryness of the house. , and any unusual hobby or hobby.
Early recognition of exposure to avian antigen and the removal of bed sheets or other irritants is essential for the recovery of patients, Dempsey emphasized.
Successful treatment
While studies have not always supported the use of steroids, in this situation they were successful, especially since Taylor also removed his feather bed cover.
"The steroids that were prescribed after diagnosis ... had a transformative effect in two days," Taylor wrote. “The course of steroids continued for 12 months, with a gradual reduction of the dose over time. Fortunately, I have been able to stop them completely. ”
“I haven't had any dizziness since I recovered. It doesn't affect me at all now and my life is almost the same as before ”
