Idiopathic pulmonary hemosiderosis as an occupational disease: a clinical case

Abstract

BACKGROUND. Idiopathic pulmonary hemosiderosis (IPH) in adults is a rare pathology of unknown etiology. We did not find information about IPH in adults with occupational hazards in the available literary sources, which makes this work relevant. OBJECTIVE. To analyze the peculiarities of the IPH course in a patient with 23 years’ experience as a gas-electric welder at factories by our own clinical observation. RESULTS AND DISCUSSION. Changes in the form of heterogeneous pneumatization of the lung parenchyma due to the increased interstitial component were determined on the computer tomography of the chest cavity (CT of the chest cavity) 1.5 years before the patient’s visit, but no additional examination was prescribed, and only the diagnosis “Chronic obstructive pulmonary disease” (COPD) was made. Negative dynamics due to the increase of miliary nodular dissemination of the lungs was revealed on the CT scan of the chest after 1.5 years. IPH was already detected pathohistologically after videothoracoscopy of the right lung with biopsy. Shortness of breath and cough increased in the patient, but apart from treatment aimed at COPD treating, no other therapy was prescribed (this therapy did not have a positive effect). The patient underwent a comprehensive immunological examination: the indicators of the anti-neutrophil cytoplasmic antibodies (ANCA) profile and the complex immunological blood test were within the normal range, which ruled out pulmonary vasculitis and an immune-mediated process. Considering the positive Quantiferon test, the patient was examined and the tuberculosis was excluded. Patient have not been suffered from hemoptysis and anemia from the moment of detection of the first changes on the CT scan of chest up to the present time. Due to treatment, the clinical and radiological stabilization of the process was determined after 4 months: the clinical symptoms of the disease decreased; small nodular shadows with areas of fibrosis, which are characteristic of the period of remission, were determined on the CT scan of the chest. CONCLUSIONS. IPH course features in a patient with a professional route are: a long period of development with COPD manifestations (without effect of therapy), absence of hemoptysis and anemia, normal indicators of the ANCA profile and complex immunological examination, a positive Quantiferon test. Corticosteroid therapy in high doses has a positive effect, which is manifested in the clinical and radiological stabilization of the process. The mechanism of IPH development may have been a toxic mechanism (23 years of work experience as a gas-electric welder at factories). Timely detection of IPH and timely prescribed corticosteroid therapy will prevent the progression of the process and the development of complications, as well as reduce mortality from this disease. Patients with IPH should be under dynamic observation due to timely evaluation of CT-dynamics of the process in the lungs and correction of the dose of corticosteroids.

Keywords

• idiopathic pulmonary hemosiderosis
• occupational disease