Hypersensitivity pneumonitis due to inhalation of spores of Pholiota nameko (P. nameko) was demonstrated. A 52-year-old male mushroom worker, noticed a dry cough, exertional dyspnea, and high fever several hours after working in the nameko cultivating house in June 1980. These symptoms only developed after working in the cultivating house. He visited our hospital on October 27. His examination revealed a bilateral basilar crepitation sound, diffuse fine granular shadows on chest X-ray, slightly decreased diffusion capacity. Intracutaneous tests using the extract from P. nameko spores were positive both for immediate and late reactions. Precipitins against P. nameko extract were detected by counterimmunoelectrophoresis but not against other molds. Histological findings by TBLB showed granulomatous alveolitis compatible with hypersensitivity pneumonitis. Provocative inhalation test with extract of the antigen showed similar symptoms and signs as in his place of work 8 hours after inhalation. Leucocytosis, positive CRP, shadows suggestive of interstitial change on chest X-ray and decrease of PaO2 and pulmonary diffusion capacity were also found. It seems to be the first case of hypersensitivity pneumonitis due to Pholiota nameko.
