The mysterious case of the saxophone lungs
A 68-year-old man sought treatment from the asthma, allergy, and immunology team at Emory Clinic. He complained of coughing and wheezing that had lasted more than a year.
His chest X-rays showed blockages with mucus and a calcified lymph node.
The man's symptoms hadn't responded to any typical treatments, including inhalers, steroids, and antibiotics.
He mentioned in passing that he performed with a Dixieland band, and that he had played clarinet for more than 30 years. "He was playing very frequently, several nights a week," says Marissa Shams, one of the Emory physicians who treated the patient.
Doctors originally thought he had allergic bronchopulmonary aspergillosis, a type of fungal reaction. Indeed, tests showed the man was allergic to several types of fungi. He was given oral steroids but didn't get any better.
What was causing his illness, and if it was an allergic reaction, how was he being exposed to the fungi?
Yep, you guessed it, the clarinet was the culprit.
Exophiala, a fungus usually found in decaying wood and soil, was discovered inside his clarinet and on its reed. "There was very impressive fungal growth on those," Shams says. The musician admitted that he hadn't thoroughly cleaned his instrument in years.
The diagnosis? "Saxophone lung," a rare type of hypersensitivity pneumonia. "Basically, he was breathing in this fungus and developed an allergic reaction," Shams says.
Once the musician started sterilizing his instrument regularly, he improved substantially.
Shams and colleagues David Berkowitz, Frances Lee, and Jennifer Shih presented the case at the annual meeting of the American College of Allergy, Asthma, and Immunology.
"We were happy to help him," Shams said. "This is not the typical allergy and asthma patient that we see in our clinic."
