title: Nonoccupational anthracofibrosis/anthracosilicosis from Ladakh in Jammu and Kashmir, India: A case series.
abstract: BACKGROUND
  Nonoccupational anthracosis and silicosis has been reported from various parts of the world including Ladakh in Jammu and Kashmir, India; however, anthracosilicosis has only been reported in industrial workers till date.
  
  
  METHODS
  Six cases from the Ladakh region in Jammu and Kashmir, India with similar clinico-radiological-pathological features, i.e., anthracosilicosis/anthracofibrosis have been analyzed. Of these, four were analyzed retrospectively and two prospectively.
  
  
  RESULTS
  All the patients were homemakers and resided in Ladakh in Jammu and Kashmir, India since birth with an age range of 42-62 years and an average age of 56 years. Their average duration of symptoms was 4 years. Spirometry showed small and/or large airway disease in 5/6 cases. On computed tomography (CT), 4/6 cases showed progressive massive fibrosis (PMF) with calcified mediastinal lymph nodes. There were random or centrilobular nodules in all the six cases. Bronchoscopy in 5/6 cases showed multiple anthracotic pigments with narrowing and distortion of the bronchus (anthracofibrosis). Malignancy was suspected clinico-radiologically in four cases and pathologically in two cases. On histopathology, anthracosis was demonstrated in all and silicosis in three cases.
  
  
  CONCLUSIONS
  Anthracosilicosis can occur due to environmental exposure. Ladakh in Jammu and Kashmir, India is the only place across the globe with unique environmental features having the presence of both free silica and biomass fuel. The disease was observed predominantly in older women. Awareness would prevent unnecessary investigation for malignancy. Treatment with the bronchodilator is useful as it has evidence of airway disease. Finally, environmental measures and a proper study need to be undertaken for knowing the relative role of silica versus soot in causing the lung disease and preventing this irreversible condition.
authors.affiliation: Department of Pulmonary Medicine, ESI-PGIMSR, Delhi, India.
authors.forename: Sonam
authors.initials: S
authors.lastname: Spalgais
authors.affiliation: Department of Pulmonary Medicine, ESI-PGIMSR, Delhi, India.
authors.forename: Dipti
authors.initials: D
authors.lastname: Gothi
authors.affiliation: Department of Chest and Tuberculosis, National Institute of Tuberculosis and Respiratory Diseases (NITRD), Delhi, India.
authors.forename: Anand
authors.initials: A
authors.lastname: Jaiswal
authors.affiliation: Department of Pathology, National Institute of Tuberculosis and Respiratory Diseases (NITRD), Delhi, India.
authors.forename: Kumud
authors.initials: K
authors.lastname: Gupta
keywords: Anthracofibrosis; anthracosilicosis; anthracosis; environmental; nonoccupational