Fatal progression of fibrotic hypersensitivity pneumonitis driven by persistent antigen exposure and socioeconomic barriers: A case report

Hypersensitivity pneumonitis (HP) is an immunological interstitial lung disease. The fibrotic form is associated with a severe prognosis, particularly in the absence of antigen avoidance.
We report the case of a 58-year-old female patient, a former wool weaver, exposed to domestic mold for 15 years. She presented with progressive exertional dyspnea evolving toward Sadoul stage IV, associated with digital clubbing and 'velcro' crackles. Computed tomography (CT) showed signs of advanced fibrosis (honeycombing, traction bronchiectasis). Bronchoalveolar lavage (BAL) revealed a macrophagic predominance (90%) and precipitins to domestic mold were positive. Despite treatment with corticosteroids, the impossibility of environmental avoidance led to the patient's death.
This case highlights the need for early recognition of domestic exposure sources to prevent irreversible progression to fibrosis.