Anthracofibrosis: A potential cause of airflow limitation

Shereen Khan, Sanaullah Tareen, Muhammad Farooq Oighor

Abstract


Background: The term “Anthracosis” was first used by Pearson while its association with airway narrowing was first described by Abraham cohen. In developed world anthracofibrosis has mainly been found to be associated with either Tuberculosis or coal dust exposure.

Objective: To define the clinical characteristics, bronchoscopic findings, histopathological and bacteriological results of patients with Anthracofibrosis.

Methodology: To define the clinical characteristics, bronchoscopic findings, histopathological and bacteriological results of patients with Anthracofibrosis.

Results: Total 62 patients diagnosed as Anthracofibrosis on bronchoscopy. Majority were female (71%), mean age at presentation was 51.4(41-65). The clinical features, bronchoscopic and histopathological findings along with bacteriological results of the Bronch-alveolar lavage (BAL) were assessed. Out of total, 07 patients were smoker, only 03 patients had significant history of smoking (>20 pack years, all male). 02(3.2%) of the patients had occupational exposure to coal dust; 56 patients (90.3%) had history of domestic fuel smoke exposure and 04 (6.5%) pts had no history of occupational
or environmental exposure. Major symptoms were cough 46 (74%),
dyspnea 44 (71%) and fever 10(16%). Of 17 patients referred from internal medicine, 09 were reported bronchogenic carcinoma on CT chest, 05 with non- resolving pneumonia and 03 with lobar collapse.
Bronchoscopically RUL was the most frequent site involved (68%) followed by RML (57%). Multilobar involvement was found in 44 cases (71%) and rest 18(29%) had unilobar involvement. Histopathology revealed non specific acute and chronic inflammatory changes with black/brown igments, 03 patients had granulomatous inflammation, and 02 patients were reported to have endobronchial neuromas with immunohistochemical taining positive for S-100. BAL smear/culture for AFB was positive in 05 (8%) patients (these were different frompts with histopathology of granulomatous inflammation).

Conclusion: Anthracofibrosis is mainly associated with tuberculosis and coal dust exposure in non Asian population where as it is associated with domestic smoke exposure in our region. Usual presentation is with cough, dyspnea and/or fever. The segmental collapse may mimic bronchogenic carcinoma.






Keywords


Anthracosis; CoalWorkers; TB; Pakistan

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