A patient comes to your office complaining of shortness of breath. This is her 6th time presenting to your office complaining of the same thing. You've started to see a trend in her history in that she always gets better when she gets a note to be excused from work. You then ask her about when her symptoms get better and she responds, "It always seems like I get so much better on the weekends. I'm able to do the things I want without feeling so tired and out of breath. I've been starting to dread coming in to work every Monday. Can you please get me out of work again today?"
1. You realize that an occupational hazard may be causing her distress.
Where does she work?
A textile factory with daily contact to cotton, linen, and hemp products. Probably exposure to bacterial endotoxin from gram-negative bacteria growing on the cotton.
2. You remember the following pathology image. Describe what you see and what the pathogenesis is.
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| "This is an example of hypersensitivity pneumonitis that can occur when there is an inhaled organic dust that produces a localized for of type III hypersensitivity (Arthus) reaction from antigen-antibody complexes. The symptoms of dyspnea, coughing, and fever abate when the affected person leaves the environment where the offending antigen is located. There are no major long-term complications." -Webpath |
She probably has Byssinosis, which is a hypersensitivity pneumonitis due to exposure. She feels better when the inciting agent is removed...any time she is away from work.
4. Which will you find if you tested her blood at work.
a. IgE Antibodies (Type I Hypersensitivity)
b. Eosinophilia
Trick question. None of the above. Muahahahahaha.
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