Mushroom worker's lung caused by spores of Hypsizigus marmoreus (Bunashimeji) - Elevated serum surfactant protein D levels

This is a report on two patients with occupational hypersensitivity pneumon itis (HP) caused by spores of Hypsizigus marmoreus (Bunashimeji) and serial follow-up measurements of serum surfactant protein D (SP-D) levels. The di agnosis of HP was confirmed immunologically by the detection of serum preci pitins to spores of Bunashimeji, but not to other antigens, and; by the pos itive results of in vitro lymphocyte proliferative response for Bunashimeji antigens using BAL fluid lymphocytes. This is the first case report of HP caused by Bunashimeji, Serum SP-D levels for the two patients (493 and 226 ng/mL; cut off level, 110 ng/mL) were elevated at diagnosis and decreased a fter separation from antigens following corticosteroid therapy. However, in one patient who returned to the same job, the symptoms appeared again and SP-D level also increased.