It was a case that easily could have presented in any urgent care center, and one that shows the importance of probing beyond social and medical history, including a patient’s profession and hobbies if necessary. The patient presented with a 7-year history of breathing difficulty that had recently worsened. The only related detail seemed to be that he had been diagnosed with hypersensitivity pneumonitis (HP, also known as farmer’s lung and hot tub lung) 5 years prior. However, he was a nonsmoker with no connective tissue disease, and his home had been checked for mold. Upon questioning, the physician learned that the patient’s symptoms improved during a 3-month stay in Australia, only to return in full force when the patient was back home in the UK. When an x-ray suggested pneumonia, he was prescribed a progression of antibiotics, antibacterials, and fungicidal agents—all to no avail. The patient’s lung capacity continued to worsen inexplicably, and he died.

Now, a researchers writing in Thorax suggest his course was due to HP after all, but with a novel origin: the man played the bagpipes daily, something that never came up in the doctor’s office. Recent tests showed Paecilomyces variottiFusarium oxysporum, Rhodotorula mucilaginosa, and Penicillium species all living in the instrument’s airbag, and yeast and mold in various other components. His condition improved in Australia because he’d left his pipes at home. “If that had been identified earlier, and he had stopped playing the bagpipes or cleaned them regularly, he may well have just gotten better,” Jenny King, the study’s lead author, told USA Today. The “bagpipe lung” case is a reminder for urgent care clinicians to ask about patients’ hobbies, along with more typical histories, when treating a patient whose symptoms are hard to pin down.

Probe Deeper if Symptoms Just Don’t Add Up
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