Extrinsic allergic alveolitis with pulmonary edema

Background. - Extrinsic allergic alveolitis may hale a chronic, subacute or acute course. Its fulminant form with interstitial edema is unusual. Case report. - An 11-year-old girl was referred to our intensive care unit because she suffered from high fever. Chest X-rays showed bilateral alveolitis. History revealed home exposure to several birds for many years, and episodes of dyspnea and fever for a few months. Diagnosis of extrinsic allergic alveolitis was confirmed by strongly positive results of precipitins to avian antigens, In addition, a paramyxovirus influenzae was recovered from broncho-alveolar lavage. Treatment including high dose steroids, hydroxychloroquine, and suppression of antigenic exposure allowed weaning from mechanical ventilation after 50 days. Severe pulmonary restriction was disclosed by lung function testing following weaning and slow improvement occurred 5 months later despite persistent interstitial lesions on chest X-rays. Conclusion. - Extrinsic allergic alveolitis may mimick an acute respiratory distress syndrome. Documenting bird exposure in such a case helps to achieve appropriate diagnosis which requires early administration of steroids in order to improve viral and functional prognosis.