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Correspondence |

Silicosis: Hidden Behind TB? FREE TO VIEW

Alkesh Kumar Khurana, MD, FCCP; Anup Kumar Singh, MD, FCCP
Author and Funding Information

From the Department of Pulmonary Medicine (Dr Khurana), Government Medical College and Hospital; and the Department of Internal Medicine (Dr Singh), Unity Hospital.

Correspondence to: Alkesh Kumar Khurana, MD, FCCP, Government Medical College and Hospital, Pulmonary Medicine, GMCH Sec 32 Chandigarh, 160030 India; e-mail: lungcancer@rediffmail.com


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;139(4):967-968. doi:10.1378/chest.10-2900
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To the Editor:

We read with great interest the case report of a 53-year-old man with dysphagia, anorexia, and night sweats by Ferguson and Schwarz in a recent issue of CHEST (November 2010).1 We believe a few issues need to be addressed after going through this report.

Although a diagnosis of TB was confirmed on sputum cultures, coexistence of a concomitant pneumoconiosis (eg, silicosis in this case) cannot be ruled out because there is a history of exposure to the cement industry. Silicotuberculosis is a well-described entity in literature, and it is said that silicosis increases the predisposition toward TB.2 The parenchymal nodules on chest radiograph and diffuse miliary pattern with mediastinal lymphadenopathy on CT scan described in this patient can be associated with silicosis.3 In this patient, the miliary shadows could be present because of preexisting silicosis and right upper lobe infiltrate because of superadded TB infection. Flexible bronchoscopy (transbronchial lung biopsy and BAL) or, preferably, open lung biopsy might have helped to rule out concomitant silicosis in this case.4 Patients with silicotuberculosis may have resistance to antitubercular medications, and they may need a longer duration of treatment as compared with TB alone5; hence, it is important to recognize concomitant silicosis in the context of this case report.

Pleuritic chest pain and pericardial effusion on echocardiogram suggest the diagnosis of pericardial TB, but the authors did not mention this in their final diagnosis. Moreover, steroids should have been added for treatment of pericardial TB in addition to standard anti-TB regimen.6

Ferguson JH, Schwarz MI. A 53-year-old man with dysphagia, anorexia, and night sweats. Chest. 2010;1385:1266-1270. [CrossRef] [PubMed]
 
Rees D, Murray J. Silica, silicosis and tuberculosis. Int J Tuberc Lung Dis. 2007;115:474-484. [PubMed]
 
Kim KI, Kim CW, Lee MK, et al. Imaging of occupational lung disease. Radiographics. 2001;216:1371-1391. [PubMed]
 
Nugent KM, Dodson RF, Idell S, Devillier JR. The utility of bronchoalveolar lavage and transbronchial lung biopsy combined with energy-dispersive x-ray analysis in the diagnosis of silicosis. Am Rev Respir Dis. 1989;1405:1438-1441. [CrossRef] [PubMed]
 
A controlled clinical comparison of 6 and 8 months of antituberculosis chemotherapy in the treatment of patients with silicotuberculosis in Hong Kong. Hong Kong Chest Service/tuberculosis Research Centre, Madras/British Medical Research Council. Am Rev Respir Dis. 1991;1432:262-267. [PubMed]
 
Blumberg HM, Burman WJ, Chaisson RE, et al; American Thoracic Society, Centers for Disease Control and Prevention and the Infectious Diseases Society American Thoracic Society, Centers for Disease Control and Prevention and the Infectious Diseases Society American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: treatment of tuberculosis. Am J Respir Crit Care Med. 2003;1674:603-662. [CrossRef] [PubMed]
 

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References

Ferguson JH, Schwarz MI. A 53-year-old man with dysphagia, anorexia, and night sweats. Chest. 2010;1385:1266-1270. [CrossRef] [PubMed]
 
Rees D, Murray J. Silica, silicosis and tuberculosis. Int J Tuberc Lung Dis. 2007;115:474-484. [PubMed]
 
Kim KI, Kim CW, Lee MK, et al. Imaging of occupational lung disease. Radiographics. 2001;216:1371-1391. [PubMed]
 
Nugent KM, Dodson RF, Idell S, Devillier JR. The utility of bronchoalveolar lavage and transbronchial lung biopsy combined with energy-dispersive x-ray analysis in the diagnosis of silicosis. Am Rev Respir Dis. 1989;1405:1438-1441. [CrossRef] [PubMed]
 
A controlled clinical comparison of 6 and 8 months of antituberculosis chemotherapy in the treatment of patients with silicotuberculosis in Hong Kong. Hong Kong Chest Service/tuberculosis Research Centre, Madras/British Medical Research Council. Am Rev Respir Dis. 1991;1432:262-267. [PubMed]
 
Blumberg HM, Burman WJ, Chaisson RE, et al; American Thoracic Society, Centers for Disease Control and Prevention and the Infectious Diseases Society American Thoracic Society, Centers for Disease Control and Prevention and the Infectious Diseases Society American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: treatment of tuberculosis. Am J Respir Crit Care Med. 2003;1674:603-662. [CrossRef] [PubMed]
 
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