- D3.496 - When music makes you bleed: suspected mould-triggered hypersensitivity pneumonitis from a contaminated trumpet in a 17-year-old professional player

Background

Hypersensitivity pneumonitis (HP) is an immune-mediated interstitial lung disease driven by repeated inhalation of organic antigens. Haemoptysis is an atypical presenting feature and may divert evaluation towards infection or haemorrhage syndromes, delaying recognition of an exposure-driven condition. In adolescents with atopic comorbidity, identifying the relevant aeroallergen exposure is central to diagnosis and—crucially—treatment through allergen avoidance.

Case

A 17-year-old professional trumpet player with established atopic disease and asthma (on regular controller therapy) was admitted for evaluation of recurrent haemoptysis (four episodes over several months). He was clinically stable and afebrile; routine blood tests, including haemoglobin and coagulation indices, were within reference ranges. Chest CT demonstrated right middle-lobe ground-glass change with apparent endobronchial material. After multidisciplinary radiology–pulmonology review, diffuse alveolar haemorrhage was considered unlikely and HP was included among leading diagnoses. Flexible bronchoscopy demonstrated a dark clot near the right main bronchus, blood-tinged secretions, erythematous bronchial mucosa with small mucosal elevations, and a polypoid-appearing lesion in RB6; bronchoalveolar lavage was performed and the lesion was biopsied, with transient procedure-related bleeding controlled endoscopically. Given the strong suspicion of an inhalational trigger relevant to allergic airway/lung disease, targeted environmental sampling was undertaken: a swab from the trumpet cultured Purpureocillium lilacinum (mould). Importantly, exposure mitigation was followed by clinical resolution: on follow-up the patient had replaced his trumpet and instituted regular disinfection with isopropyl alcohol, after which haemoptysis ceased.

Conclusion

This case highlights a modifiable, occupation-related aeroallergen source in plain sight: a mould-contaminated wind instrument acting as a reservoir for repeated antigen exposure and an HP-like presentation with haemoptysis. For allergists, the key message is practical—when HP is suspected, meticulous exposure history should extend to musical instruments and other personal equipment. Wind instruments are a plausible but under-recognised source of high-intensity, repetitive aeroallergen exposure due to internal moisture retention and biofilm formation. Targeted sampling plus allergen avoidance may be both diagnostic and therapeutic.