Abstract:
Background The incidences of silicosis co-occurring with organizing pneumonia are rarely reported and ofen misdiagnosed due to insufcient understanding by clinicians.
Objective This article aims to explore the clinical, radiological, and pathological features of silicosis complicated with organizing pneumonia.
Methods The clinical manifestations, laboratory tests, radiological images, pathological features, treatment, and prognosis were retrospectvely analyzed in 119 silicosis with organizing pneumonia cases from March 2012 to January 2018 in First Hospital of Quanzhou Afliated to Fujian Medical University.
Results There were 119 patients including 116 males and 3 females with a mean age of (48.7±8.8) years. All patents were stonecuters with a mean occupatonal silicon dioxide partcles exposure history of (30.0±7.1) years. The main clinical manifestatons were cough (95.8%), sputum production (87.4%), fever (71.4%), dyspnea (66.4%), and moist rales (60.5%). The results of laboratory tests showed elevaton of erythrocyte sedimentaton rate(66.6±26.6) mm/h, serum level of C-reactve protein(110.8±73.0) mg/L, and neuron-specifc enolase (median, 28.19 μg/L), as well as moderate or severe hypoxemia (median oxygenaton index, 214 mmHg). All patents showed typical radiological images of silicosis. The results of CT scans showed multple patchy alveolar opacites, usually bilateral and in lower lobe, with bronchial distribution. The positive rate of lung biopsy was 78.4%. Histologically, widened bronchial septa and pulmonary intersttal fbrosis were noted in all patents; polypoid growth of granulaton tssues with silicon dioxide partcles depositon were presented within small airways and alveolar spaces; with Masson staining, organizing fbers were found blue. All patents received glucocortcoid therapy, and the therapeutc effects were evaluated 1 month afer the treatment:98 patents (82.3%) achieved a complete response, 19 patents (16.0%) achieved a partal response, and 2 patents (1.7%) died of progressive aggravaton. Moreover, 35 patents experienced 85 relapses over a follow-up of 4-74 months (median, 14 months), and dramatc response to resumed therapy was observed in the relapse cases.
Conclusion Silicosis complicated with organizing pneumonia has no specifc manifestatons, and is ofen misdiagnosed as infectous pneumonia, requiring comprehensive diagnosis based on the clinico-radiologic-pathologic features. Glucocortcoid treatment is effectve, though some patents have relapses.
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