Never Feed Birds in the Hot Tub! A Case of Bird-Fancier’s Lung

A 50-year-old female non-smoker with a past medical history of rheumatoid arthritis and asthma presented to the pulmonology clinic with a chief complaint of acute on chronic exertional dyspnea for 6 months. The patient was discharged from the hospital 2 weeks prior and was given the diagnosis of acute hypoxemic respiratory failure secondary to asthma exacerbation. She was discharged with a 7-day course of prednisone, which temporarily improved her dyspnea, and an outpatient referral was placed.

At her initial presentation to the pulmonology clinic, the patient was afebrile with a peripheral oxygen saturation on room air showing 93% saturation. Examination was notable for short inspiratory wheezes with mid-inspiratory squeaks in both lung fields. Laboratory testing showed an elevated C-reactive protein with a normal brain natriuretic peptide and hemoglobin. Infectious evaluation, previously performed in the inpatient setting, was unremarkable. Extensive rheumatologic workup was also negative, including rheumatoid factor and anti-cyclic citrullinated peptides. A detailed exposure history was obtained in the pulmonary clinic using the CHEST Interstitial and Diffuse Lung Disease Patient Questionnaire,1 which revealed the patient had a hobby of handling bird feeders and regularly utilized a hot tub to alleviate her arthritic pain. The patient had started handling and cleaning bird feeders about 18 months prior to presentation. The patient’s daily hot tub routine was initiated 12 months prior. To read this article in its entirety, please visit our website.