A retired shipyard worker with rapidly progressive pulmonary interstitial fibrosis.

Abstract

We present a case of progressive interstitial fibrosis in a retired shipyard worker who was exposed to asbestos during the postwar era of the late 1940s and 1950s, when asbestos exposures in the workplace were not regulated. Forty years later, at 63 years of age, the patient presented with restrictive lung disease. The patient was diagnosed with asbestos-related pleural disease and parenchymal asbestosis. He remained stable for the next 7 years, but then he began to manifest rapid clinical progression, which raised the possibility of an unusual variant of asbestosis, a concomitant interstitial process, or an unrelated disease. Lung biopsy was not undertaken because of the patient's low pulmonary reserve and limited treatment options. An empiric trial of oral steroids was initiated, but his pulmonary status continued to deteriorate and he died of pulmonary failure at 72 years of age. Many diseases result in pulmonary interstitial fibrosis. Ideally, open lung biopsy should be performed, but this procedure inevitably causes complications in many patients with end-stage restrictive lung disease. Furthermore, while the presence of asbestos bodies in tissue sections is a sensitive and specific marker of asbestos exposure, neither this finding nor any other charge is a marker indicative of asbestosis or the severity of asbestosis. With the enactment of the Asbestos Standard in the United States, asbestos exposures have been decreasing in this country. However, industries that produce asbestos products and wastes continue to expand in developing countries. Prevention of asbestos-related lung disease should be a global endeavor, and asbestos exposures should be regulated in both developed and developing countries. Images Figure 1 Figure 2 Figure 3 Figure 4

Occult Adenocarcinoma of the Lung Mimicking Rapid Progression of Asbestosis

“…However, our findings indicate that the extensive fibrosis was more than just progression of asbestosis. First, although asbestosis can progress after the cessation of asbestos exposure and cases of fatal asbestosis have been reported (6), rapid progression of asbestosis is rare, which should raise the possibility of other or concomitant fibrosing conditions (7). Moreover, the relatively light burden of asbestos fiber in the present case defies the central role of asbestosis in the fibrosing process, because there is a dose-response relationship between the concentration of fibers and the extent of the fibrosis (8).…”