title: Acute exacerbation of idiopathic pulmonary fibrosis after inhalation of a water repellent.
abstract: The natural course of idiopathic pulmonary fibrosis (IPF) is unpredictable at the time of diagnosis. Some patients may experience episodes of acute respiratory worsening that have been termed acute exacerbations. A 58-year-old male was admitted to our Emergency Department due to progressive and intense dyspnea and dry cough after accidental inhalation of waterproof's vapor containing siloxanes. Chest high resolution computed tomography (HRCT) scan showed diffuse and bilateral ground glass attenuation, basal predominant reticular abnormalities and subpleural honeycombing. The patient didn't know that he suffered from IPF and siloxanes' inhalation triggered an acute exacerbation of his disease. Clinical course after the inhalation was aggressive and, despite steroids and cyclophosphamide therapy, the patient died 3 months after due to a respiratory failure. Inhalation of water repellents has been associated with an acute onset of respiratory symptoms and acute lung injury; usually, however, the prognosis is commonly good with a complete recovery. Our case is an example of an extremely negative reaction probably because of pre-existing and misdiagnosed IPF. Currently, no literature concerning water repellent inhalation as a trigger of acute exacerbation of IPF is available.
authors.affiliation: University of Siena, Siena, Italy (Department of Medical and Surgical Sciences and Neurosciences, Respiratory Diseases Unit). david.btt@gmail.com.
authors.forename: David
authors.initials: D
authors.lastname: Bennett
authors.affiliation: University of Siena, Siena, Italy (Department of Medical and Surgical Sciences and Neurosciences, Respiratory Diseases Unit).
authors.forename: Elena
authors.initials: E
authors.lastname: Bargagli
authors.affiliation: University of Siena, Siena, Italy (Department of Medical and Surgical Sciences and Neurosciences, Respiratory Diseases Unit).
authors.forename: Rosa Metella
authors.initials: RM
authors.lastname: Refini
authors.affiliation: University of Siena, Siena, Italy (Department of Medical and Surgical Sciences and Neurosciences, Respiratory Diseases Unit).
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Pieroni
authors.affiliation: University of Siena, Siena, Italy (Department of Medical and Surgical Sciences and Neurosciences, Respiratory Diseases Unit).
authors.forename: Antonella
authors.initials: A
authors.lastname: Fossi
authors.affiliation: University of Siena, Siena, Italy (Department of Medical and Surgical Sciences and Neurosciences, Occupational Medicine Unit).
authors.forename: Riccardo
authors.initials: R
authors.lastname: Romeo
authors.affiliation: University of Siena, Siena, Italy (Department of Medical and Surgical Sciences and Neurosciences, Diagnostic Imaging Unit).
authors.forename: Luca
authors.initials: L
authors.lastname: Volterrani
authors.affiliation: University of Siena, Siena, Italy (Department of Medical and Surgical Sciences and Neurosciences, Diagnostic Imaging Unit).
authors.forename: Maria Antonietta
authors.initials: MA
authors.lastname: Mazzei
authors.affiliation: University of Siena, Siena, Italy (Department of Medical and Surgical Sciences and Neurosciences, Respiratory Diseases Unit).
authors.forename: Paola
authors.initials: P
authors.lastname: Rottoli
mesh_terms: D000208:Acute Disease; D018450:Disease Progression; D017809:Fatal Outcome; D006801:Humans; D054990:Idiopathic Pulmonary Fibrosis / Q000139:chemically induced* / Q000175:diagnosis; D001239:Inhalation; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure / Q000009:adverse effects*; D013227:Steam / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed
chemical_list: D013227:Steam
keywords: acute exacerbation; chemical hazard; idiopathic pulmonary fibrosis; occupational exposure; siloxanes; water proof inhalation