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A2578 - Progressive Massive Fibrosis in a Worker Outside the Coal Industry in New Mexico
Author Block: L. Casaus1, A. Sood2; 1Internal Medicine, UNM, Albuquerque, NM, United States, 2Division of Pulmonary, Critical Care and Sleep Medicine, University of New Mexico, Albuquerque, NM, United States.
Classical silicosis includes a spectrum of disease states from simple silicosis to progressive massive fibrosis (PMF), resulting from inhalational silica exposure. The intensity and duration of exposure as well as host susceptibility dictates the presentation and progression of PMF. Although most cases of PMF in the literature are reported among coal miners in whom this disease has shown a recent increase in prevalence, this disease can also be seen in exposed workers outside the coal industry. In this presentation, we will review the clinical, physiological, and pathological manifestations of the disease, illustrated by a case example of PMF among a non-coal miner from New Mexico. Diagnosis and management of patients with PMF can be difficult, and carries medicolegal implications for the patient. Physicians and policymakers need to be aware of PMF in workers exposed to silica within and outside the coal industry. An 83-year-old man presented in 2017 worsening dyspnea over the prior 10 years. He worked at a federal national laboratory in Los Alamos, New Mexico, from 1962-1992 as a construction worker. His work included digging ditches, removing insulation, demolishing buildings, breaking up concrete with jackhammers, and working around sandblasters in enclosed areas, without any respiratory protection. He had a 5-pack year smoking history, and quit 50 years prior. A 2017 chest radiograph showed small, upper lobe predominant, nodular opacities. A high resolution computed tomography (CT) scan in 2009 showed innumerable micronodules in the upper lobes of the lung with a centrilobular distribution. A repeat CT scan obtained in 2017 (Figure 1) showed new-onset coalescence of several upper lobe nodules, as large as 1.5 cm x 2 cm. His pulmonary function tests (PFT) showed mild obstruction with evidence of air trapping. A diagnostic bronchoscopy showed no evidence of infection or neoplasm. PMF represents the coalescence of smaller radiographic pneumoconiotic opacities to those over 10 millimeters in size. The rate of PMF in American coal miners has recently increased. Although most cases of PMF are reported among coal miners, this is likely a reflection of the fact that coal miners undergo active surveillance due to governmental regulations. In this presentation, we report PMF in a worker outside the coal industry. Physicians and policymakers need to be aware of this condition in workers exposed to silica within and outside the coal industry.