Mixed Dust Pneumoconiosis - Not in the Usual Setting

Abstract

INTRODUCTION: Pneumoconioses are a group of interstitial lung diseases caused by inhalation of certain dusts and the lung tissue's reaction to the dust.Usually associated with occupational exposure. We describe a case of mixed dust pneumoconiosis in an elderly woman with no history of exposure to any dust. CASE PRESENTATION: 68 year old female presented with worsening shortness of breath for two months. She has had shortness of breath on exertion for 8 years associated with nonproductive cough.She denied occupational or environmental exposures but she used firewood for cooking for 30 years. She recently migrated to the United States from Pakistan. Her CXR and chest CT scan showed multiple bilateral pulmonary nodules in a perilymphatic distribution associated with hilar and mediastinal lymphadenopathy. Bronchoscopy revealed extensive anthracotic pigmentation of the tracheobronchial mucosa but transbronchial biopsy was inconclusive. She then had a video assisted thoracoscopic biopsy and the pathology revealed anthracotic pigment laden macrophages and negatively birifringent needles consistent with mixed dust fibrosis. DISCUSSION: Mixed dust pneumoconiosis was recognized among women using biomass fuels for cooking in Africa. The term > was coined by early researchers who found this condition was prevalent in the Transkei region of Africa; while others have used the term > was coined by early researchers who found this condition was prevalent in the Transkei region of Africa; while others have used the term > for this condition. Biomass combustion releases smoke that contains particulate matter1. Evidence suggests exposure to high levels of particulate matter causes lung inflammation and chronic bronchitis2. Clinical manifestations are nonspecific and range from asymptomatic3 in early disease to dyspnea, cough, cyanosis and inspiratory crackles on auscultation. This suggests that early disease can be masked by the lack of or nonspecific nature of symptoms. Radiologic findings are nonspecific and include reticulonodular opacities, mediastinal and hilar lymphadenopathy. Characteristic findings reported on bronchoscopy and bronchoalveolar lavage include anthracotic pigmentation of bronchi and carbon laden macrophages on Bal Lung histopathology obtained by transbronchial or open lung biopsy is the gold standard for the diagnosis of hut lung. CONCLUSIONS: Our case demonstrates that while evaluating women from rural areas of developing countries with nonspecific pulmonary symptoms and radiographic abnormalities, mixed dust pneumoconiosis should be considered and detailed work, personal history should be obtained. While clinical manifestations and radiologic findings are nonspecific, lung histopathology either transbronchial or open lung biopsy is diagnostic and will often preclude unnecessary treatments.