Hypersensitivity Pneumonia Due to Resin Inhalation in a Violin Player

Respirable organic chemicals are known to cause respiratory conditions such as bronchial asthma and interstitial lung diseases. As well as occupational exposure, there is also the risk of inhalation during various hobbies. In the literature, there are cases of occupational asthma due to exposure to resin inhalation. Here, we present the first case of HP due to resin inhalation by a violinist, which is the first reported case in the literature. A 31-year-old female patient presented with complaints of exertional shortness of breath persisting for a year and a cough that had developed in the last three months. Approximately three months ago, the patient was admitted to a private hospital for a week due to suspected pneumonia, based on infiltrates observed on chest radiography. She was an active smoker. Her medical history revealed that she had no pets at home and no occupational exposure; however, she mentioned playing the violin as a hobby. Further questioning revealed that her shortness of breath worsened, particularly after resin was applied to the violin bow. Examination of the respiratory system revealed distinct bilateral inspiratory crackles, which were more pronounced on the left side. Thoracic computed tomography revealed widespread centrilobular ground-glass nodules, widespread thickening of the bronchial walls, and ground-glass opacities in all lobes, especially in the lower lobes. Fiberoptic bronchoscopy was performed. The lymphocyte rate in the bronchoalveolar lavage (BAL) was 9% and the CD4/CD8 ratio was 1.11. The council decided to proceed with wedge resection lung biopsy. Histopathological analysis of the lung specimen revealed extensive interstitial pigmented macrophages and foreign body giant cells. Interstitial fibrosis was observed in the parenchyma, which was reported to be pneumoconiosis or hypersensitivity pneumonia compatible with resin exposure. Methylprednisolone treatment was initiated for the patient who was diagnosed with fibrotic HP and the exposure was terminated. This case highlights the importance of considering occupational and hobby-related exposures in the diagnosis of interstitial lung diseases. We believe that using validated questionnaires in polyclinics for professionals and hobbies that are at risk for HP will contribute to the determination of exposure.