Severe Bilateral Pulmonary Fibrosis in a Young Syrian Refugee

Abstract

SESSION TITLE: Critical Care 3 SESSION TYPE: Affiliate Case Report Slide PRESENTED ON: Sunday, October 29, 2017 at 04:30 PM - 05:30 PM INTRODUCTION: A civil war in Syria has generated a humanitarian crisis affecting the health care of its citizens and refugees. Environmental lung diseases in areas of conflict may pose significant health implications. Numerous challenges in providing health care to these individuals exist including lack of medical records, inability to confirm toxic exposures, and distrust in foreign medical teams. We discuss the case of a young Syrian refugee who presented with severe bilateral fibrotic lung disease complicated by bilateral pneumothoraces. CASE PRESENTATION: A 35 year old male Syrian refugee developed worsening dyspnea since his arrival to the United States a few days prior to his presentation. He was cachectic and had decreased bilateral breath sounds. Chest computed tomography revealed bilateral coarse reticular opacities, innumerable peri-lymphatic and centrilobular nodules, confluent fibrotic-type consolidative opacities in all lung lobes, and bilateral pneumothoraces. He developed acute hypoxic respiratory failure requiring mechanical ventilation. Bilateral chest tubes were placed. He underwent bronchoscopy with bronchial alveolar lavage and transbronchial biopsies demonstrating non-specific focal fibrosis, foreign body type giant cell reaction, and focal airspace hemorrhage. A tracheostomy was placed. It was evident he was initially concerned about disclosing historical details due to uncertainty of implications. He reported a brief history of working with glass, but biopsy findings were not consistent with silicosis. Investigation for infectious etiologies was negative. His immigration documents also noted negative tests for tuberculosis. Overall, his evaluation suggested a non-specific environmental lung disease. He acknowledged exposure to dust, fumes, gases and smoke at conflict zones but was unable to identify them. The severity of his lung disease precluded surgical biopsy. His treatment was determined to be mostly supportive with the goal of rehabilitation and consideration of future lung transplantation. DISCUSSION: This case is an example of accelerated non-specific fibrotic lung disease in a young refugee from war-torn Syria. In the absence of alternative diagnosis, it is imperative to consider this patient's exposure to war conditions as a potential risk factor for development of environmental lung disease. Careful examination of all information available including immigration documents and building a trustful patient-doctor relationship are essential in the care of such patients. CONCLUSIONS: More than 4.5 million people have fled Syria since the beginning of a major political conflict in 2011 [1]. The medical community should remain alert to the potential health implications of environmental lung diseases in war zone areas. The number of refugees exposed to toxic substances is unknown, and this population may be at significant risk for development of lung disease. Reference #1: Syria Emergency. The UN Refugee Agency. UNHCR.org. Accessed Mar 6, 2017. DISCLOSURE: The following authors have nothing to disclose: Susan Vehar, Humberto Choi No Product/Research Disclosure Information