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Occupational and Environmental Lung Diseases |

Bronchial Anthracofibrosis

Lindsay Somerville, MD; Meghan Cooper, MD
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University of Virginia, Charlottesville, VA


Chest. 2015;148(4_MeetingAbstracts):761A. doi:10.1378/chest.2223056
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Abstract

SESSION TITLE: Occupational and Environmental Lung Diseases Case Report Posters

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM

INTRODUCTION: Bronchial anthracofibrosis, or inflammatory bronchial stenosis with anthracotic pigmentation, is a condition characterized by fibrotic narrowing of the segmental bronchi with black fibrotic deposits on the mucosa and submucosa. It is associated with tuberculosis and exposure to biodiesel fuel products, and is rarely observed in North America.

CASE PRESENTATION: A 78 year old Salvadoran woman presented with a history of dyspnea on exertion, subacute low grade fevers, and chronic cough. She had a reported history of chronic obstructive pulmonary disease and recurrent hospitalizations for pneumonia. She had no known sick contacts and denied hemoptysis, sputum production, or weight loss. Throughout most of her adult life she used an indoor wood stove, over which she manufactured soap, and was a nonsmoker. Computed tomography of the chest showed atelectasis of the right middle lobe, diffuse centrilobular nodules, tree-in-bud opacities in the lingula, bibasilar areas of bronchiectasis, and paraseptal emphysema. Bronchoscopy revealed multiple anthracotic, subcentimeter plaque-like lesions adherent to the bronchial and secondary bronchial mucosal surfaces, predominantly distributed in the upper lobes, consistent with bronchial anthracofibrosis. Narrow band imaging was negative. Bronchoalveolar lavage and induced sputum culture yielded mycobacterium tuberculosis.

DISCUSSION: Bronchial anthracofibrosis is thought to represent a chronic inflammatory response to mycobacterium tuberculosis, often in the setting of biomass fuel exposure, in the absence of significant coal or cigarette exposure. While it has been observed with some frequency in the Middle East, India, and South Korea, it is rarely reported in North America and Europe. Evolution of immigration patterns over the last decade suggest that bronchial anthracofibrosis may be on the rise in the Western World.

CONCLUSIONS: Bronchial anthracofibrosis is a condition associated with tuberculosis in the setting of biomass fuel exposure. While rarely observed in North America, it is important to recognize due to its strong association with active mycobacterium tuberculosis.

Reference #1: Chung MP, et al. Bronchial Stenosis Due to Anthracofibrosis. Chest. 1998 Feb; 113(2):344-350.

Reference #2: Kala J, Sahay S, Shah A. Bronchial anthracofibrosis and tuberculosis presenting as a middle lobe syndrome. Prim Care Resp J. 2008; 17(1):51-55.

Reference #3: Hwang J, et al. Bronchial anthracofibrosis and tuberculosis in immigrants to Canada from the Indian subcontinent. Int J Tuberc Lung Dis. 2010 Feb;14(2):231-237.

DISCLOSURE: The following authors have nothing to disclose: Lindsay Somerville, Meghan Cooper

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