Silicosis, then microscopic polyangiitis—antineutrophil cytoplasmic antibodies‐associated vasculitis may be work‐related disease in patients with silicosis

Published on May 2, 2017in Journal of General and Family Medicine
· DOI :10.1002/JGF2.77
Yoshito Nishimura5
Estimated H-index: 5
,
Tomohiro Tsuda2
Estimated H-index: 2
+ 4 AuthorsToshihiko Nagao1
Estimated H-index: 1
Sources
Abstract
: A 74-year-old man with silicosis was admitted to the hospital because of prolonged fever. After referral to internal medicine for persistent fever and renal dysfunction, workup revealed antineutrophil cytoplasmic antibodies (ANCA) positivity. He was diagnosed with microscopic polyangiitis (MPA). After treatment with immunosuppressive therapy, his condition improved. Herein, we discuss silica exposure and the risk of ANCA-associated vasculitis (AAV), particularly in terms of work-related diseases. Silica exposure is a notorious risk factor for developing AAV, which is potentially lethal when not identified. When we see a silicosis patient with new-onset prolonged fever and generalized fatigue, AAV should be taken into consideration. This case report provides beneficial information to reliably assess patients at high risk of developing AAV in primary care settings.
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Abstract Microscopic polyangiitis (MPA) is an idiopathic autoimmune disease characterized by systemic vasculitis. The disease predominantly affects small-calibre blood vessels and is associated with the presence of antineutrophil cytoplasmic autoantibodies (ANCA). Microscopic polyangiitis was considered to be a disease entity by Savage et al. in 1985. Microscopic polyangiitis has a reported low incidence and a slight male predominance. The aetiology of MPA remains unknown. There is, however, inc...
38 CitationsSource
#1Suni Lee (Kawasaki Medical School)H-Index: 6
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Silica particles and asbestos fibers, which are known as typical causatives of pneumoconiosis, induce lung fibrosis. Moreover, silicosis patients often complicate with autoimmune diseases, and asbestos-exposed patients suffer from malignant diseases such as pleural mesothelioma and lung cancer. We have been conducting experimental studies to investigate altered regulation of self-tolerance caused by silica exposure, including analyses using specimens such as plasma and immunocompetent cells obta...
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Background Crystalline silica is among the environmental exposures associated with increased risk of autoimmune diseases, including rheumatoid arthritis, systemic sclerosis and systemic lupus erythematosus. Silica exposure has also been related to the development of ANCA-associated vasculitides (AAV), but past studies appear to conflict as to the presence and magnitude of the associated risks of disease. We aimed to conduct a systematic review of the existing studies and meta-analysis of their r...
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Abstract Autoimmune disorders are induced by various environmental and occupational substances. Among the most typical factors involving these substances, it is well known that silica exposure causes not only pulmonary fibrosis known as silicosis, but also induces autoimmune diseases such as rheumatoid arthritis known as Caplan's syndrome, systemic sclerosis, systemic lupus erythematosus, and anti-neutrophil cytoplasmic autoantibody (ANCA)-related vasculitis/nephritis. To investigate the immunol...
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Anti-neutrophil cytoplasmic antibodies, directed against constituents of granules of neutrophils and lysosomes of monocytes, are serological markers of small vessel vasculitides, including Wegener's granulomatosis, microscopic polyangiitis, Churg-Strauss syndrome and renal-limited vasculitis. These vasculitides are collectively termed ANCA-associated vasculitides (AAV). Environmental factors have been considered important in the development of ANCA, including silica, infection especially with St...
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Occupational silica exposure has been associated with an increased risk for several autoimmune diseases (1) as well as with nephritis and end-stage renal disease (ESRD) (2-4). Studies of silica exposure in the development of small-vessel vasculitis (SVV) have consistently supported an association (4-10). However, previous studies suffered from considerable limitations, including small sample sizes, use of various case definitions, and limited information on exposure. Only one previous study inco...
94 CitationsSource
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Background Exposure to silica dust is considered to be one of etiological factors of antineutrophil cytoplasmic antibodies (ANCA) -associated vasculitis (AAV). Methods Subjects exposed to silica dust in Central Bohemia and followed in the Department of Occupational Medicine, Charles University, were selected for study. A group of 86 men exposed to SiO2 for at least 5 years were examined. The association between occupational exposure to silica dust and ANCA positivity is analyzed. Results The sub...
35 CitationsSource
#1Karen B. Mulloy (UNM: University of New Mexico)H-Index: 4
Work in Department of Energy (DOE) facilities has exposed workers to multiple toxic agents leading to acute and chronic diseases. Many exposures were common to numerous work sites. Exposure to crystalline silica was primarily restricted to a few facilities. I present the case of a 63-year-old male who worked in DOE facilities for 30 years as a weapons testing technician. In addition to silica, other workplace exposures included beryllium, various solvents and heavy metals, depleted uranium, and ...
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Cited By4
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#1Cunxiang Bo (Academy of Medical Sciences, United Kingdom)H-Index: 8
#2Xiao Geng (Academy of Medical Sciences, United Kingdom)H-Index: 4
Last. Hua Shao (Academy of Medical Sciences, United Kingdom)H-Index: 12
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Silicosis is a systemic disease characterized by chronic persistent inflammation and incurable pulmonary fibrosis with the underlying molecular mechanisms to be fully elucidated. In this study, we employed tandem mass tag (TMT) based on quantitative proteomics technology to detect differentially expressed proteins (DEPs) in lung tissues of silica-exposed rats. A total of 285 DEPs (145 upregulated and 140 downregulated) were identified. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genom...
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#1N Rao (St. Vincent's Health System)
#2A Bendall (St. Vincent's Health System)
Last. M Lanteri (St. Vincent's Health System)
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There is a recognized association between silica exposure and Antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV); however, no clear association between silica exposure and Immunoglobulin A (IgA) nephropathy. We describe the case of a 26-year-old male stonemason who presents with hilar lymphadenopathy, haematuria and acute kidney injury related to silica exposure, AAV and IgA nephropathy. He was asymptomatic on presentation; urinalysis revealed glomerular haematuria (>1000 r...
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#1Zhaoqiang Zhang (Jining Medical University)H-Index: 3
#2Chun-zhi Zhang (Jining Medical University)H-Index: 3
Last. Li Lin (Jining Medical University)H-Index: 3
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Abstract Silicosis is a serious occupational disease affecting millions of related workers. Many studies showed lung macrophages play an important role in the disease. However, the changes of macrophages are not fully characterized and the mechanisms need further investigations. The objectives of this work were to evaluate the effects of abnormal expression of fusion and fission genes on the morphology and function of lung macrophage mitochondria in SiO2-induced silicosis fibrosis in rats. In th...
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#1Nitesh Gupta (Safdarjang Hospital)H-Index: 2
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: A 28-year-old male was admitted for breathlessness, haemoptysis, fever and fatigue. The patient had occupational exposure to silica dust. Arterial blood gas test ABG revealed hypoxemic respiratory failure. Chest CT demonstrated ground glass opacities with interlobular septal thickening and small centrilobular nodules with patchy areas of consolidation in bilateral lungs. He was mechanically ventilated for refractory hypoxemia. The treatment with cyclophosphamide and methylprednisolone lead to ...
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