一名没有明显病史的 63 岁女性因 3 天疲劳和劳力呼吸困难病史被送往紧急护理中心。经检查，她的室内空气氧饱和度低于 80 度，并被转移到最近的医院进行进一步评估。最初的胸片显示双侧广泛的间质混浊，有利于中下肺。一般的感染性检查并未发现任何问题。她的症状被认为是非典型细菌或病毒感染所致。她出院回家，通过鼻插管补充氧气，流量为 2 升/分钟；指示完成 7 天的抗生素疗程；并给予严格的退货预防措施。六天后，尽管完成了规定的抗生素疗程，但她还是因呼吸困难恶化而返回急诊室。她被收入院接受进一步评估。她于 2000 年代初从印度北部移民。在印度，烹饪是在明火上进行的。他们的家位于一个家禽养殖场。她从来不抽烟。她了解典型癌症筛查的最新情况。她没有养宠物，并否认自搬到美国后进一步接触鸟类。她的职业经历包括制造业，但她否认大量接触灰尘或金属刨花。版权所有 © 2024 美国胸科医师学会。由爱思唯尔公司出版。保留所有权利。

A 63-year-old woman without significant medical history presented to an urgent care center with a 3-day history of fatigue and dyspnea on exertion. She was found to have an oxygen saturation in the low 80s on room air and was transferred to the closest hospital for further evaluation. Initial chest radiographs showed extensive bilateral interstitial opacities favoring the mid to lower lungs. A general infectious workup was unrevealing. The cause of her symptoms was thought to be an atypical bacterial or viral infection. She was discharged home on supplemental oxygen, 2 L/min via nasal cannula; instructed to finish a 7-day course of antibiotics; and given strict return precautions. Six days later she returned to the ED with worsening dyspnea despite finishing the prescribed course of antibiotics; she was admitted for further evaluation. She had emigrated from Northern India in the early 2000s. While in India, cooking was performed over an open fire. Their home was situated on a poultry farm. She has never smoked. She was up to date on typical cancer screening. She had no pets and denied further exposure to birds since moving to the United States. Her occupational history included manufacturing, but she denied significant exposure to dusts or metal shavings.Copyright © 2024 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.