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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Hypersensitivity pneumonitis &#40;HP&#41; is a heterogeneous interstitial lung disease resulting from repeated exposure to organic or inorganic antigens&#46; While rare in the pediatric population&#44; with an estimated prevalence of 4 cases per million children&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> common triggers in children include bird antigens&#44; fungal aerosols&#44; and certain drugs&#46; HP manifests as acute&#44; sub-acute&#44; or chronic forms&#44; diagnosed based on &#40;1&#41; documented antigen exposure&#44; &#40;2&#41; compatible respiratory symptoms&#44; &#40;3&#41; decreased carbon monoxide transfer factor or exertional hypoxia&#44; &#40;4&#41; specific radiologic features&#44; and &#40;5&#41; lymphocytic alveolitis&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> Treatment involves antigen avoidance and occasionally corticosteroids&#46; Here&#44; we present a case of a 5-year-old girl diagnosed with HP due to exposure to turtledove droppings&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 5-year-old girl was referred to our tertiary hospital for &#8220;recurrent asthma attack&#8221; with hypoxemia requiring three hospitalizations in one month&#46; She had no prior history of asthma or atopy&#44; either personally or in her family&#46; She had experienced dyspnea and a dry cough for two months&#44; accompanied by fever for one day at symptom onset and anorexia&#46; On admission&#44; she had tachypnea &#40;57&#47;min&#41; with saturation at 88&#37; in room air&#44; needing supplemental oxygen&#46; Chest auscultation was normal&#46; Chest X-ray showed fine reticulation and diffuse opacities&#46; A detailed environmental history revealed prolonged exposure to domestic turtledove &#40;6 months&#41;&#44; with excreta all over the apartment&#46; Her respiratory signs were improved during hospitalization with steroid treatment but worsened upon each discharged at home&#46; CT scan showed diffuse centro-lobular ground glass opacities &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Broncho-alveolar lavage &#40;BAL&#41; confirmed lymphocytic alveolitis with 1500<span class="elsevierStyleHsp" style=""></span>cells&#47;mm<span class="elsevierStyleSup">3</span> including 30&#37; lymphocytes &#40;normal range&#58; &#60;10&#37;&#41;&#46; The CD4&#47;CD8 ratio was reversed &#40;0&#46;6&#59; normal range&#58; 0&#46;9&#8211;2&#46;5&#41;&#46; Serum precipitin tests were positive for avian serum &#40;IgG pigeon 91<span class="elsevierStyleHsp" style=""></span>mgA&#47;L&#44; IgG chicken 32<span class="elsevierStyleHsp" style=""></span>mgA&#47;L&#59; normal range<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>30&#44; FEIA method&#41;&#44; corroborated by the presence of specific arch &#40;bird fancier&#39;s&#41;&#46; Other causes of interstitial lung disease were ruled out through BAL studies&#44; immunological assessments&#44; and infectious disease screenings&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The patient was treated with 24<span class="elsevierStyleHsp" style=""></span>h of oxygen and oral prednisone at 1<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;day with tapering for a total of 3 months&#46; Upon discharge with avoidance advice&#44; the patient showed excellent evolution during follow-up&#46; Her apartment was cleaned&#44; and the bird was removed&#46; After three months of steroid treatment&#44; she had no more dyspnea&#44; oxygen pulse oximetry was 99&#37;&#44; and she gained weight&#46; Lung volume and DLCO was not possible because of her age&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">HP is often underrecognized by pediatricians&#44; leading to delayed diagnosis averaging between 1 and 11 months&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> with the risk of irreversible pulmonary fibrosis&#46; Clinical recognition relies on exposure history and respiratory findings&#46; Predominant pediatric triggers include bird or fungal antigens&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Our case highlights HP in a 5-year-old exposed to domestic turtledove droppings&#44; with only one similar case reported&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> Despite pigeons being more commonly cited&#44; the allergens are common to both species&#44; as they belong to the same taxonomic family&#44; Columbidae&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> This case underlines the importance of environmental exposure interrogation in front of interstitial lung disease&#44; for accurate diagnosis and treatment&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0025" class="elsevierStylePara elsevierViewall">This research did not receive any specific grant from funding agencies in the public&#44; commercial&#44; or not-for-profit sectors&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors&#8217; contributions</span><p id="par0030" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0035" class="elsevierStylePara elsevierViewall">Maggiolino Quentin&#58; Conception and writing of the article&#46; Bibliography collection&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0040" class="elsevierStylePara elsevierViewall">Socchi Floriane&#58; Critical revision of the article&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0045" class="elsevierStylePara elsevierViewall">Renoux Marie-Catherine&#58; Final approval of the article&#46;</p></li></ul></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors declare not to have any conflicts of interest that may be considered to influence directly or indirectly the content of the manuscript&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Artificial intelligence involvement</span><p id="par0055" class="elsevierStylePara elsevierViewall">No material in this manuscript has been produced with the help of any artificial intelligence software or tool&#46;</p></span></span>"
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Journal Information
Vol. 60. Issue 10.
Pages 656-657 (October 2024)
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Vol. 60. Issue 10.
Pages 656-657 (October 2024)
Clinical Letter
Hypersensitivity Pneumonitis in a 5-Year-Old Girl due to Turtledove: A Case Report
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Maggiolino Quentin
Corresponding author
q-maggiolino@chu-montpellier.fr

Corresponding author.
, Renoux Marie-Catherine, Socchi Floriane
Department of Pediatric Pulmonology, Montpellier University Hospital, Montpellier, France
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