title: An elderly 'kawara' craftsman with acute kidney injury and haemoptysis: a case of silica-induced autoimmunity.
abstract: A 62-year-old Japanese 'kawara' (ceramic roof tile) craftsman presented with acute kidney injury and haemoptysis. This case met the systemic lupus erythematosus and microscopic polyangiitis criteria, with high titres of myeloperoxidase-antineutrophil cytoplasmic antibody (570 EU). Results showed the presence of antinuclear antibody at a high titre (1:2560), but detection of rheumatoid factor, anti-dsDNA, anti-SSA and anti-SSB antibodies was not apparent. This serology was similar to drug-induced, silicon-induced or silica-induced autoimmunity. The patient had been exposed to silica for > 40 years. The environmental aetiology of autoimmune diseases should be considered in cases that show atypical epidemiology and serology.
authors.affiliation: Department of Nephrology and Hypertension , Mitsubishi Kyoto Hospital , Kyoto , Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Matsui
authors.affiliation: Department of Nephrology and Hypertension , Mitsubishi Kyoto Hospital , Kyoto , Japan.
authors.forename: Hiroko
authors.initials: H
authors.lastname: Tsuji
authors.affiliation: Department of Nephrology and Hypertension , Mitsubishi Kyoto Hospital , Kyoto , Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Ono
keywords: SLE; adjuvant effect; p-ANCA; silica