Table of Contents Author Guidelines Submit a Manuscript
Canadian Respiratory Journal
Volume 17, Issue 5, Pages e102-e105
Case Report

Hazards of the ‘Hard Cash’: Hypersensitivity Pneumonitis

Elif Kupeli,1 Demet Karnak,2 Serpil Dizbay Sak,3 and Oya Kayacan2

1Department of Pulmonary Diseases, Baskent University School of Medicine, Turkey
2School of Medicine, Department of Chest Diseases, Ankara University, Turkey
3Department of Pathology, Baskent University School of Medicine, Ankara, Turkey

Copyright © 2010 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Hypersensitivity pneumonitis (HP) is a nonimmunoglobulin E-related immune-mediated parenchymal lung disease. A 45-year-old woman who was a lifelong nonsmoker with a six-month history of frequent episodes of cough and dyspnea was admitted to hospital. She had been working as a money counter for 20 years at a central bank. Bibasilar crackles on lung auscultation, ground-glass opacities and a mosaic pattern on high-resolution computed tomography, restrictive abnormality on pulmonary function tests and mild hypoxemia were the prominent findings. Bronchoalveolar lavage fluid analysis revealed a predominance of CD4-positive T cells, and she tested positive on her natural challenge test. She was diagnosed with subacute HP based on established criteria. She was advised to discontinue counting fresh banknotes. Prednisolone was commenced, then tapered to discontinue in the ensuing six months. Clinical and radiological improvement was achieved within two months. To the authors’ knowledge, the present report is the first to describe ‘hard cash HP’, possibly caused by chipping dust or printing dye.