Interstitial lung disease induced by endogenous Candida albicans

We report on a 64-year old woman with an interstitial lung disease which had characteristics of hypersensitivity pneumonitis. Severe febrile attacks with impairment of ventilation and diffuse poorly defined radiodensities and ground glass opacities on chest x-ray occured repeatedly. Laboratory data showed hyoxemia, leukopenia and circulating Candida albicans (C.a.)-antigen. Bronchoalveolar lavage revealed an increase in neutrophils. Transbronchial biopsies showed lymphocytic alveolitis, bronchiolitis obliterans and epitheloid cell granulomas. IgG and IgA and the lymphocyte proliferation assay were positive with C.a.-antigen. C.a. was detected in the feces. Intradermal skin test with C.a. showed a positive immediate and late phase reaction and inhalative provocation test with C.a.-antigen was positive. After antimycotic treatment the symptoms resolved completely and long-lasting. We conclude that the disease was induced by C.a.-antigen reaching the lungs from the intestinal tract via the bloodstream.