A CASE OF ACUTE SILICOSIS WITH SEVERE PULMONARY HYPERTENSION

Abstract

SESSION TITLE: Medical Student/Resident Occupational and Environmental Lung Disease SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Silicosis occurs from inhalation of silica dust particles. Acute and accelerated silicosis share nodular formations as seen in chronic silicosis but have granular lipo-proteinaceous collections in the alveolar spaces [1]. These collections impair gas exchange resulting in cyanosis, and ultimately respiratory failure usually exacerbated by respiratory infections. We report a case of a young patient developing acute silicosis from working in a gold mine. CASE PRESENTATION: A 30-year-old African man presented with a 2-week history of worsening shortness of breath associated with productive cough and pleuritic chest pain. The patient was previously diagnosed with progressive massive fibrosis (PMF) and silicosis via lung biopsy at an outside hospital, attributed to a 3-year long silica exposure from gold mining in West Africa. Our patient was initiated on intravenous glucocorticoids, broad spectrum antibiotics, and noninvasive positive pressure ventilation for acute hypoxic and hypercarbic respiratory failure. Chest radiograph revealed extensive bilateral airspace opacities (figure 1). CT-chest showed extensive bilateral perihilar parenchymal opacities with traction bronchiectasis, consistent with PMF (figure 2)(figure 3). Transthoracic echocardiogram showed septal wall abnormalities and a right ventricular systolic pressure of 173 mmHg measured via tricuspid regurgitant jet. The patient’s condition stabilized during hospitalization and the patient was discharged home on prednisone and oxygen supplementation via nasal cannula. Three weeks after discharge, the patient presented again with recurrent acute respiratory failure with a positive viral PCR for RSV requiring intubation and mechanical ventilation. Shortly after intubation, the patient went into cardiac arrest and expired. DISCUSSION: Generally, silicosis presents as a chronic condition but rarely, acute silicosis, most often related to massive exposure, can present within a few years . Lung transplantation is the only definitive treatment of advanced silicosis with studies showing successful lung transplantation with the 6-month, 1-year and 3-year survival rates of 86, 86, and 76 percent respectively [2]. One case report examined initiation of intravenous glucocorticoid therapy followed by oral prednisone which showed transient improvement in chest radiography and pulmonary function tests [3]. Unfortunately, treatment with glucocorticoid therapy was unable to alter the outcome of our patient. Lung transplantation was in the process for the patient but was unable to be obtained. CONCLUSIONS: This case presents a rare case of acute silicosis/PMF with severe pulmonary hypertension, who developed respiratory failure after RSV infection leading to death. Reference #1: Ozkan M, Ayan A, Arik D, Balkan A, Ongürü O, Gümüş S. FDG PET findings in a case with acute pulmonary silicosis. Ann Nucl Med 2009;23:883–886. Reference #2: Singer, J. P., et al. “Survival Following Lung Transplantation for Silicosis and Other Occupational Lung Diseases.” Occup Med (Lond) 62.2 (2012): 134-7. Print. Reference #3: Goodman, George B., et al. “Acute Silicosis Responding to Corticosteroid Therapy.” Chest 101.2 (1992): 366-70. Print. DISCLOSURES: No relevant relationships by Khaled Abu-Ihweij, source=Web Response No relevant relationships by Sung Choi, source=Web Response no disclosure on file for Keith Guevarra; No relevant relationships by John Wisener, source=Web Response