Page 2 has a great picture
This patient is experiencing hypersensitivity pneumonitis from the parakeets. I was thinking M. Avium when I selected parakeets -- I think my logic was flawed given the specifics of the patient's story.
Hypersensitivity pneumonitis—mixed type III/IV hypersensitivity reaction to environmental antigen. Causes dyspnea, cough, chest tightness, headache. Often seen in farmers and those exposed to birds. Reversible in early stages if stimulus is avoided.
It's a type of restrictive lung disease.
I also was thinking M. avium here, but hypersensitivity pneumonitis seems to fit with the reticulogranular changes.
how do we know parakeets cause hypersensitivy pneumonitis
according to uworld hypersensitivity pneumonitis is due to dust and that was also an option....
Psittacosis (sometimes called ornithosis or parrot disease or parrot fever) is an infection of the lung (pneumonia) caused by the bacterium Chlamydophila (Chlamydia) psittaci.
Signs and symptoms:
cough, usually without much phlegm.
shortness of breath.