Farmer's Lung

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Abstract
Exposure to unusual quantities of moldy farm dusts occasionally results in an easily recognized disease with distinct clinical, physiologic, and pathologic features. The characteristic syndrome seen in 73 agricultural workers consisted of chills, fever, and dyspnea within a few hours after exposure to moldy farm dusts and the subsequent development of a diffuse interstitial pneumonitis. Lung biopsies from 8 patients during the subsiding phase of the disease revealed a specific acute granulomatous interstitial pneumonitis. Characteristically, the sections showed epithelioid cells, poorly defined tubercles, and giant cells of the Langhans'' type, together with thickening of the alveolar septa which also were infiltrated with plasma cells and lymphocytes. Physiologic studies revealed the equally characteristic syndrome of a stiff lung with a reduced diffusing capacity, and non-uniform distribution of regional ventilation and blood flow. The functional derangement correlated directly with the structural alterations seen in the histologic sections. The lesion is usually reversible, but occasionally progressive interstitial fibrosis will develop. This unique disease will probably be encountered frequently in rural areas where climatic conditions necessitate the storage of large quantities of winter forage.

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