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Correspondence |

Occupational Anthracofibrosis FREE TO VIEW

Jean-Marc Naccache, MD; Isabelle Monnet, MD; François Guillon, MD; Dominique Valeyre, MD
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Affiliations: Hôpital Universitaire Avicenne Assistance Publique-Hôpitaux de Paris Bobigny, France,  Centre Hospitalier Intercommunal de Créteil Créteil, France,  Hôpital Universitaire Avicenne Assistance Publique-Hôpitaux de Paris Bobigny, France

Correspondence to: Jean-Marc Naccache, MD, Hôpital Universitaire Avicenne, Service de Pneumologie, 125 Rue de Stalingrad, Bobigny 93000, France; e-mail: jean-marc.naccache@avc.aphp.fr


The authors have reported to the ACCP that no significant 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 (www.chestjournal.org/site/misc/reprints.xhtml).


© 2009 American College of Chest Physicians


Chest. 2009;135(6):1694. doi:10.1378/chest.08-2864
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To the Editor:

We read with great interest the recent article in CHEST (November 2008) by Wynn and colleagues1 reporting on patients with anthracofibrosis, possibly due to occupational exposure. Anthracofibrosis is defined as a narrowing of the bronchial lumen with overlying anthracotic mucosa that is most frequently attributed to tuberculosis.2 The authors described six patients with anthracofibrosis without a history of tuberculosis but with a history of occupational exposure. The patients were exposed to coal dust and other dust known to induce bronchial mucosa black tattoos. The occurrence of anthracofibrosis with bronchial narrowing suggests an extreme manifestation of tattoos due to dust exposure.

In a recent article,3 we described three patients with anthracofibrosis that was attributed to mixed mineral dust exposure. None of the patients had a history of tuberculosis. They had experienced occupational exposure to silica, silica and aluminum, and silica and asphalt. Mineralogical analysis by transmission electron microscopy of BAL fluid, pulmonary, hilar, or bronchial samples found high levels of particle retention. Two patients had high percentages of free crystalline silica and mica, and the third patient had high percentages of free crystalline silica, kaolin, and other silicates. These findings suggested that mixed mineral dust was the cause of the anthracofibrosis.

Together with our observations, the article by Wynn et al1 strengthens the link between occupational exposure and anthracofibrosis. In patients with authracofibrosis, the taking of a detailed history of potential exposures is critical. We would like to emphasize that exposures other than those to coal could lead to anthracofibrosis. Moreover, mineralogical analysis can identify the presence of causative mineral dusts.

Wynn GJ, Turkington PM, O'Driscoll BR. Anthracofibrosis, bronchial stenosis with overlying anthracotic mucosa: possibly a new occupational lung disorder; a series of seven cases from one UK hospital. Chest. 2008;134:1069-1073. [PubMed] [CrossRef]
 
Chung MP, Lee KS, Han J, et al. Bronchial stenosis due to anthracofibrosis. Chest. 1998;113:344-350. [PubMed]
 
Naccache JM, Monnet I, Nunes H, et al. Anthracofibrosis attributed to mixed mineral dust exposure: report of three cases. Thorax. 2008;63:655-657. [PubMed]
 

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References

Wynn GJ, Turkington PM, O'Driscoll BR. Anthracofibrosis, bronchial stenosis with overlying anthracotic mucosa: possibly a new occupational lung disorder; a series of seven cases from one UK hospital. Chest. 2008;134:1069-1073. [PubMed] [CrossRef]
 
Chung MP, Lee KS, Han J, et al. Bronchial stenosis due to anthracofibrosis. Chest. 1998;113:344-350. [PubMed]
 
Naccache JM, Monnet I, Nunes H, et al. Anthracofibrosis attributed to mixed mineral dust exposure: report of three cases. Thorax. 2008;63:655-657. [PubMed]
 
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