International Journal of Current Research and Review
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IJCRR - 8(21), November, 2016

Pages: 47-50

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PROGRESSIVE MASSIVE FIBROSIS IN A CASE OF SILICOSIS- A CASE REPORT

Author: Vishnukanth Govindaraj, Ravindrachary Mulkoju, BallaNagamalli Kumar, Vishal Kumar Chitkeshi, Adimulam Ganga Ravindra

Category: Healthcare

Abstract:Aim: Silicosis also known as potters rot is the most common occupational lung disease. People employed in occupations like sandblasting, surface drilling, tunneling, silica flour milling, ceramic making are predisposed to developing silicosis. We report a case of progressive massive fibrosis secondary to silicosis in a stone quarry worker.
Case Report: A forty five year old stone quarry worker presented with chronic dry cough and breathlessness. His chest CT showed presence of multiple calcified mediastinal lymphnodes with irregular mass like areas. Based on the occupational exposure and radiographic images, a diagnosis of progressive massive fibrosis due to silicosis was made.
Discussion: Pneumoconiosis is group of lung diseases related to occupational exposure to inhaled dust. The most common among pneumoconiosis is silicosis. Based on the amount and duration of exposure the clinical and radiological features of silicosis vary. Progressive massive fibrosis is a potentially fatal stage in complicated silicosis. In a majority of cases, a positive occupational history and radiological features are sufficient to make a diagnosis.
Conclusion: There is no specific treatment for silicosis. Avoidance of further exposure, using personal protective measures, periodic medical checkup and strict legislations to protect employees and a system to check compliance should be ensued.

Keywords: Progressive massive fibrosis, Silica dust

Full Text:

INTRODUCTION:

Progressive Massive Fibrosis(PMF)  is a potentially fatal and debilitating occupational hazard occurring in persons  working  in respirable dust industries1. This condition most commonly occurs in association with occupational lung diseases like coal workers pneumoconiosis and silicosis. We report a patient with progressive massive fibrosis secondary to silicosis. The diagnosis was established by occupational history and radiological features.

CASE DESCRIPTION:

A forty five year old man presented with symptoms of dry cough and breathlessness on exertion of six months duration. He was not a smoker  and had no previous history of tuberculosis. He had worked in a stone quarry for twenty years and  had no co morbid illness. On examination his vitals were stable. On Respiratory examination there were bilateral  scattered crepts .  His chest x ray(fig 1)showed  diffuse reticulonodular opacities and multiple mass-like symmetrical lesions with irregular margins in the hilar region bilaterally. High resolution computed tomography (HRCT) of  chest revealed presence of multiple calcified  mediastinal lymphnodes with  irregular mass likes areas in the bilateral upper and left lower lobe predominately in the hilar and peri hilar region . Few specks of calcification were  noted within the lesion.  There were also multiple nodules of  varying sizes with  centrilobular and perilymphatic distribution.(fig2,3) Imaging, supported by occupational history  was suggestive of progressive massive fibrosis (PMF) due to silicosis. The patient is currently on symptomatic management and has not worsened till the last contact.

DISCUSSION:

Silicosis also known as “potters rot” is an important  occupational lung disease caused by inhalation of crystalline silica. Silicon is abundant in nature as free silica in combination with oxygen(quartz) or as silicates in combination with oxygen and other elements.  Silicon contributes to about 28% of the earth's crust and a major part exists in quartz form2 .  The sand stone industry, stone quarrying and dressing, granite industry, grinding of metals, sand blasting, iron and steel foundries, silica milling, flint crushing and manufacture of abrasive soaps are some of the occupations related to silica exposure.  Slate pencil industry and agate grinding industry which are peculiar to India carry a high risk of silicosis2-4.  Crystallinesilica is classified as a group 1 substance by the InternationalAgency for Research on cancer5.

 

Silicosis has affected humans since ages.  In 1705, Ramazzini cited Diembrock's description of the lungs of stonecutters who possibly had silicosis6. The term silicosis was coined by Visconti in 18707.  Though occurring  since ages,  due to industrialization and mechanized mining, the prevalence of silicosis has increased alarmingly  in the twentieth century. In 2007, the U.S. Occupational Safety and Health Administration (OSHA) estimated that more than two million employees are exposed to silica in general industry, construction, and maritime industry8. Epidemiological studies on silicosis in India has shown  varied   prevalence ranging from 3.5% in ordnance factory to 54.6% in slate pencil industry.4

 The primary pathology in silicosis is the formation of silicotic nodules. The inhaled silica particle are engulfed by the alveolar macrophages. However they are unable to digest the material.  The  silica particle in the macrophages damages the lysosomal membranes of the alveoli which triggers the release of proteolytic enzymes into the cytoplasm leading to  death of the macrophage. Continued  exposure    results in  an alteration of the macrophage function. Release of inflammatory cytokines like interleukin 1, free radicals and growth factors follows  which stimulates collagen synthesis and production of antibodies against collagen. These anticollagen antibodies stimulate fibroblasts to then produce more collagen which eventually leads to  silicotic nodule formation3,9.

 

Based on the amount, duration of exposure and onset of symptoms,  silicosis can be classified as acute silicosis , chronic silicosis and accelerated silicosis. "Chronic simple silicosis", the commonest form, develops after long   term exposure usually  10-30 years to smaller amounts of silica dust.  "Accelerated silicosis" develops 5-10 years after exposure and progresses rapidly with a higher risk of complicated disease.  "Acute silicosis" also called Silicoproteinosis develops a few weeks to 5 years after exposure to high concentration of silica dust.Acute silicosis progresses rapidly to respiratory failure and death.  Whensevere scarring leads to confluence of small nodulesinto a larger lesion with more severe symptoms andrespiratory impairment, it is termed as "Complicatedsilicosis". It is more common in accelerated type thanwith the chronic variety10.

Majority of the patients present in chronic silicotic stage. Even in the presence of advanced radiological lesions, patients are asymptomatic.The most common symptom is  dyspnoea on exertion .The severity of dyspnoea increases with progress of the disease. Cough is associated with  minimal expectoration in the initial stages and the productivity increases as the disease advances. Chest pain and haemoptysis indicate the possibility of complication like tuberculosis. In late stages corpulmonale results. Silicosis may be complicated with other lung diseases including lung cancer and autoimmune diseases. Patients with silicosis are  more susceptible to developing  pulmonary tuberculosis, "silicotuberculosis"6. Patients with  silicosis  are also  prone to develop   repeated Infections, chronic obstructive pulmonary disease and tracheobronchial compression by enlarged mediastinal lymphnodes. Pleural involvement in silicosis is rare. Few instances of bilateral pneumothorax has  been reported3.

Radiological lesions vary in different types of silicosis. On HRCT thorax, multiple bilateral centrilobular opacities, multifocal patchy ground-glass opacities, and consolidation with occasional crazy paving characterize acute silicosis. Chest x ray of patients with   chronic simple silicosis   shows the  presence of multiple small nodules, 2-5 mm in diameter  with  associated calcifications. These nodules have a upper lobe predominance.  HRCT in chronic simple silicosis  shows perilymphatic distribution of nodules  in centrilobular, paraseptal, and subpleural regions.  Hilar and mediastinal lymphadenopathy may precede the parenchymal lesions. Eggshell pattern calcification of lymph nodes is common. Complicated silicosis, also known as progressive massive fibrosis, develops with confluence of individual silicotic nodules. On  CT scan , PMF  appears as  focal soft-tissue masses, usually  measuring more than 1 cm in diameter, with irregular margins, calcification, and  involving apical and posterior segments of the upper lobes, surrounded by areas of emphysematous changes.  With advancing  fibrosis, these  opacitiesmigrate towards hila with  resultant  paracicatricial emphysema. In silicosis associated with tuberculosis(silicotuberculosis) the radiological picture incudes  asymmetric nodules or consolidation, cavitation and a  rapid disease progression11,12.

 

Silicosis is usually diagnosed by eliciting a positive occupational exposure history. A positive occupational history with radiological features of silicosis is sufficient to make a diagnosis of silicosis. Lung biopsy is rarely required. Lung biopsy may show the presence of silicotic nodules. A typical silicotic  nodule has the following characteristics; a central zone with whorls of dense, hyalinized fibrous tissue,  a midzone with concentrically arranged collagen fibers  and an  outer zone with randomly orientated collagen fibers mixed with dust-loaded macrophages and lymphoid cells9. Patients of silicosis should be screened for tuberculosis6.

There is no specific treatment for silicosis. Avoidance of further exposure is the first step in treatment. Only a few treatment options are available and they are mostly for symptomatic management.  Bronchodilators and corticosteroid therapy may be useful13,14. N-Acetyl cysteine has shown reduction in lung fibrosis in silica exposed rats15.Lung transplant has been an option for end-stage disease treatment. However, logistic reasons prevent advising lung transplant for all patients. It should be remembered that silicosis is a completely preventable disease. Education to workers , use of personal protective  equipment and periodic medical screening  should be made compulsorily. If PMF is diagnosed  the person should immediately  cease work in the industry. Strict legislations to protect employees and a system to check compliance should be ensued.

CONCLUSION:

Silicosis is a common occupational disease which can present even after cessation of exposure. Majority of the patients can be diagnosed by eliciting a proper occupational exposure history. There is no specific treatment. Strict legislations with regard to using personal protective equipment in the occupational area and a periodic health check up for the employees is the need of the hour. In countries with high incidence of Tuberculosis, possibility of silico tuberculosis should always be considered.

ACKNOWLEDGEMENT:

Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.

SOURCE OF FUNDING: NONE

CONFLICT OF INTEREST: NONE

References:

  1. Progressive massive fibrosis. www2.isu.edu/radsci/papers14/05_2014. Accessed on 01/05/2016 at 23:00 hrs.
  2. G.K.Kulkarni. Prevention and control of silicosis- a national challenge.Indian J Occup Environ Med. 2007  11(3): 95–96.
  3. Mishra P, Jacob SE, Basu D, Panigrahi MK, Govindaraj V. Bilateral spontaneous pneumothorax in chronic silicosis: a case report. Case Reports in Pathology. 2014;2014:561861-561861.
  4. Silicosis - An Uncommonly Diagnosed Common Occupational Disease.icmr bulletin 1999;29(9).
  5. IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, Silica, Some Silicates, Coal Dust and Para-Aramid Fibrils, vol. 68, IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, Lyon, France, 1997.
  6. MY Ali, SA Alam, F Fattah, MT Ahmed, SS Parveen, M Royesuddin, MN Ahmed, SY Ali. Silicosis - A Case Report. Faridpur Med. Coll. J. 2010;5(2):69-71.
  7. Basil Varkey.http://emedicine.medscape.com/article/302027-overview.Published dec 2015.  Date accessed 01/05/2016.
  8. Carson R. Thomas and Timothy R. Kelley. A Brief Review of Silicosis in the United States. Environmental Health Insights 2010:4 21–26
  9.  Brooke T. Moosman, Andrew Churg. Mechanisms in the Pathogenesis ofAsbestosis and Silicosis.Am J Respir Crit Care Med1998;  157(5) 1666-1680.
  10. Vincent Castranova, Val Vallyathan. Silicosis and Coal Workers' Pneumoconiosis. Environmental Health Perspectives; Vol 108, Supplement2000 Aug;pg.675-684.
  11. Satija B, Kumar S, Ojha UC, Gothi D. Spectrum of high resolution computed tomography imaging in occupational lung disease. Indian J Radiol Imaging 2013;23:287-96.
  12. Angela santos Ferreira, Valeria barbosa Moreira. Progressive massive fibrosis in silica-exposed workers.High-resolution computed tomography findings. J Bras Pneumol. 2006;32(6):523-8
  13. Goodman GB, Kaplan PD, Stachura I, Castranova V, Pailes WH, Lapp NL. Acute silicosis responding to corticosteroid therapy. Chest. 1992; 101(2):366-70.
  14. Sharma SK, Pande JN, Verma K. Effect of prednisolone in treatment in chronic silicosis. Am Rev Respir Dis 1991; 143:814-21.
  15. Zhang L, He YL.N-acetylcysteine alleviated silica-induced lung fibrosis in rats by down-regulation of ROS and mitochondrial apoptosis signaling. Toxicol Mech Methods.2014 Mar;24(3):212-9.

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One article from every issue is selected for the ‘Best Article Award’. Authors of selected ‘Best Article’ are rewarded with a certificate. IJCRR Editorial Board members select one ‘Best Article’ from the published issue based on originality, novelty, social usefulness of the work. The corresponding author of selected ‘Best Article Award’ is communicated and information of award is displayed on IJCRR’s website. Drop a mail to editor@ijcrr.com for more details.

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This award is instituted to encourage women researchers to publish her work in IJCRR. Women researcher, who intends to publish her research work in IJCRR as the first author is eligible to apply for this award. Editorial Board members decide on the selection of women researchers based on the originality, novelty, and social contribution of the research work. The corresponding author of the selected manuscript is communicated and information is displayed on IJCRR’s website. Under this award selected women, the author is eligible for publication incentives. Drop a mail to editor@ijcrr.com for more details.

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‘Emerging Researcher Award’ is instituted to encourage student researchers to publish their work in IJCRR. Student researchers, who intend to publish their research or review work in IJCRR as the first author are eligible to apply for this award. Editorial Board members decide on the selection of student researchers for the said award based on originality, novelty, and social applicability of the research work. Under this award selected student researcher is eligible for publication incentives. Drop a mail to editor@ijcrr.com for more details.


Best Article Award

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A study by Muhas C. et al. entitled \"Study on Knowledge & Awareness About Pharmacovigilance Among Pharmacists in South India\" is awarded Best article for Vol 14 issue 22
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A study by Singh R. et al. entitled \"A Prospective Study to Find the Association of Astigmatism in Patients of Vernal Keratoconjunctivitis (VKC) in a Tertiary Health Care Centre in India (Vindhya Region MP)\" is awarded Best Article for Vol 14 issue 15
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A Study by Sarmila G. B. et al. entitled "Study to Compare the Efficacy of Orally Administered Melatonin and Clonidine for Attenuation of Hemodynamic Response During Laryngoscopy and Endotracheal Intubation in Gastrointestinal Surgeries" is awarded Best Article for Vol 13 issue 07
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A Study by Gainneos PD et al. entitled "A Comparative Evaluation of the Levels of Salivary IgA in HIV Affected Children and the Children of the General Population within the Age Group of 9 – 12 Years – A Cross-Sectional Study" is awarded Best Article of Vol 13 issue 05 Special issue on Recent Advances in Dentistry for better Oral Health
A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" is awarded Best Article of Vol 13 issue 06
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A Study by Kumari PM et al. entitled "Study to Evaluate the Adverse Drug Reactions in a Tertiary Care Teaching Hospital in Tamilnadu - A Cross-Sectional Study" is awarded Best Article for Vol 13 issue 05
A Study by Anu et al. entitled "Effectiveness of Cytological Scoring Systems for Evaluation of Breast Lesion Cytology with its Histopathological Correlation" is awarded Best Article of Vol 13 issue 04
A Study by Sharipov R. Kh. et al. entitled "Interaction of Correction of Lipid Peroxidation Disorders with Oxibral" is awarded Best Article of Vol 13 issue 03
A Study by Tarek Elwakil et al. entitled "Led Light Photobiomodulation Effect on Wound Healing Combined with Phenytoin in Mice Model" is awarded Best Article of Vol 13 issue 02
A Study by Mohita Ray et al. entitled "Accuracy of Intra-Operative Frozen Section Consultation of Gastrointestinal Biopsy Samples in Correlation with the Final Histopathological Diagnosis" is awarded Best Article for Vol 13 issue 01
A Study by Badritdinova MN et al. entitled "Peculiarities of a Pain in Patients with Ischemic Heart Disease in the Presence of Individual Combines of the Metabolic Syndrome" is awarded Best Article for Vol 12 issue 24
A Study by Sindhu Priya E S et al. entitled "Neuroprotective activity of Pyrazolone Derivatives Against Paraquat-induced Oxidative Stress and Locomotor Impairment in Drosophila melanogaster" is awarded Best Article for Vol 12 issue 23
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A Study by Ghaffar UB et al. entitled "Correlation between Height and Foot Length in Saudi Population in Majmaah, Saudi Arabia" is awarded Best Article for Vol 12 issue 21
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A Study by Avijit Singh"Comparison of Post Operative Clinical Outcomes Between “Made in India” TTK Chitra Mechanical Heart Valve Versus St Jude Mechanical Heart Valve in Valve Replacement Surgery" is awarded Best Article for Vol 12 issue 19
A Study by Sonali Banerjee and Mary Mathews N. entitled "Exploring Quality of Life and Perceived Experiences Among Couples Undergoing Fertility Treatment in Western India: A Mixed Methodology" is awarded Best Article for Vol 12 issue 18
A Study by Jabbar Desai et al. entitled "Prevalence of Obstructive Airway Disease in Patients with Ischemic Heart Disease and Hypertension" is awarded Best Article for Vol 12 issue 17
A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16
A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15
A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for  Vol 12 issue 12
A Study by Muhammet Lutfi SELCUK and Fatma entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for  Vol 12 issue 11
A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for  Vol 12 issue 10
A Study by entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for  Vol 12 issue 09
A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for  Vol 12 issue 08
A Study by Virendra Atam et. al. entitled "Clinical Profile and Short - Term Mortality Predictors in Acute Stroke with Emphasis on Stress Hyperglycemia and THRIVE Score : An Observational Study" is awarded best article for  Vol 12 issue 07
A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR
A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09

List of Awardees

A Study by Ese Anibor et al. "Evaluation of Temporomandibular Joint Disorders Among Delta State University Students in Abraka, Nigeria" from Vol 13 issue 16 received Emerging Researcher Award


A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" from Vol 13 issue 06 received Emerging Researcher Award


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Disclaimer: International Journal of Current Research and Review (IJCRR) provides platform for researchers to publish and discuss their original research and review work. IJCRR can not be held responsible for views, opinions and written statements of researchers published in this journal.



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International Journal of Current Research and Review (IJCRR) provides platform for researchers to publish and discuss their original research and review work. IJCRR can not be held responsible for views, opinions and written statements of researchers published in this journal

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