Hypersensitivity Pneumonitis: A Rural India Story | Chapter 9 | An Overview of Disease and Health Research Vol. 10

 

Dry nasal snuff, commonly known as “Chhikni” in India, is a smokeless tobacco preparation composed of finely powdered tobacco that is inhaled into the nasal cavity. Although traditionally perceived as less harmful than smoking, long-term inhalational exposure may lead to significant pulmonary complications. Hypersensitivity pneumonitis (HP) is an immune-mediated interstitial lung disease caused by repeated inhalation of sensitising antigens in susceptible individuals. The report presents the case of a 67-year-old woman with a 30-year history of chronic dry snuff inhalation (4–5 times daily) who presented with acute hypoxic respiratory failure. Clinical examination revealed diffuse crackles and wheezes with severe hypoxemia. Laboratory investigations showed leukocytosis, while inflammatory markers and autoimmune serologies were unremarkable. High-resolution computed tomography (HRCT) of the chest demonstrated bilateral mosaic attenuation with patchy ground-glass opacities suggestive of inflammatory pneumonitis. Infectious and autoimmune etiologies were excluded. Based on significant chronic inhalational exposure and radiologic findings, a diagnosis of chronic hypersensitivity pneumonitis was made.

 

The patient was treated with high-dose intravenous methylprednisolone followed by oral corticosteroids, resulting in significant clinical and radiological improvement. She was discharged on minimal home oxygen therapy with strict avoidance of further snuff exposure.

 

This case highlights dry nasal snuff as a potential but underrecognized cause of chronic hypersensitivity pneumonitis and emphasises the importance of detailed exposure history in patients presenting with unexplained interstitial lung disease.

 

 

Author(s) Details

Hairya Ajaykumar Lakhani
SBKS Medical Institute and Research Centre, Vadodara, India.

 

Miloni Mineshbhai Nada
Surat Municipal Institute of Medical Education and Research (SMIMER), Affiliated to the Veer Narmad South Gujarat University, Surat, India.

 

Aarjuv Majmundar
SBKS Medical Institute and Research Centre, Vadodara, India.

 

Sucheta Lakhani
SBKS Medical Institute and Research Centre, Vadodara, India.

 

Jitendra D Lakhani
SBKS Medical Institute and Research Centre, Vadodara, India.

 

Please see the book here :- https://doi.org/10.9734/bpi/aodhr/v10/7174