A Not so Benign Beach Trip: Coral Induced Hypersensitivity Pneumonitis

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The Florida Keys is famous for having the only living coral reef system in the continental US. Coral dust is a common, but rarely clinically significant allergen. We document here a case of a 50-year-old female who developed acute hypersensitivity pneumonitis (HP) secondary to coral dust
A 50-year-old female with past medical history of hypertension and asthma presented to the hospital with 1 week of acute progressive shortness of breath which began during a vacation to the Florida Keys. She had completed a 7-day course of fluoroquinolone therapy for symptoms of cough and sputum production prior to presentation in the ED. Upon presentation, she was afebrile, hypertensive, and oxygen saturation was 70% on room air, with significant increased work of breathing. Bipap was initiated and she was admitted to the MICU. Initial lab studies were significant for leukocytosis with eosinophilia. Chest x-ray revealed extensive bilateral infiltrates. CT angiography of the chest was performed and was negative for pulmonary embolism but demonstrated bilateral ground glass opacities. The patient was then placed on antibiotic therapy for community acquired pneumonia, but her condition did not improve with standard treatment. Immunological workup was negative. Initial consideration for HP had been abandoned as there was no exposure to any mold, dust, mites, pollen, smoke, or local allergens in her history, however on re-evaluation it was noted that while at the beach on her vacation she had been exposed to coral dust. She was then started on steroid therapy with rapid improvement in her respiratory status. She was discharged home on 2L nasal cannula.
Florida is home to north America’s only living coral reef; and approximately 2.25 million tourists annually. Currently, there are no published cases of coral dust HP. Per local news, if the winds are strong enough the coral dust is taken airborne and affects tourists who have a history of asthma or other allergies. Lack of awareness of coral dust as a possible allergen lead to a delayed diagnosis of this patient and unnecessary testing including rheumatologic profile, CTPE, antibiotics, and a prolonged hospital stay. Recognition of hypersensitivity pneumonitis is critical for treatment, as it has a distinct treatment paradigm involving steroids. The importance of a thorough history including social history is of critical importance even when evaluating patient’s in the critical care setting.


Medicine and Health Sciences


Department of Medicine, Department of Medicine Faculty, Department of Medicine Fellows and Residents, Fellows and Residents

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