PIGEON-BREEDERS DISEASE IN CHILDHOOD

Pidgeon breeder's disease is a common form of hypersensitivity pneumon itis, which is rarely diagnosed in children. We report a seven pear ol d boy, who developed cough, easy fatigue, anorexia and weight loss ove r a period of two months after having contact with pigeons. The findin gs on physical examination were tachypnoea and reduced thoracic moveme nts. Chest radiograph showed widespread fine nodular shadowing in both lung fields. Pulmonary function tests demonstrated a restrictive defe ct and an impaired diffusion. Lymphocytes were highly increased in bro nchoalveolar lavage (BAL) fluid. Precipitating antibodies against pige on excreta was found in the serum. Environmental control of pigeon pro tein and a course of systemic corticosteroids over 4 months resulted i n clinical and lung function improvement. However clinical recovery st opped over several months after discontinuation of steroid therapy. Th erefore steroid therapy was reinstalled and continued until complete c linical recovery and pulmonary function occurred, that was 20 months a fter onset of the disease. Essential for the patient was to avoid furt her contact with birds. However a prolonged steroid therapy was necess ary to achieve complete resolution. Lung function tests were useful fo r follow up and decisions on further treatment.