title: Rapid Growth of Lung Nodules due to Combined Pulmonary Vasculitis, Silicoanthracosis, and Chondrocalcinosis.
abstract: Background. Silicoanthracosis is a pneumoconiosis due to occupational inhalation of silica and carbon dusts. Clinically, it can be associated with vasculitis or rheumatoid arthritis. In association with these diseases, silicoanthracosis can present within the lung with multiple pulmonary nodules which, as a differential diagnosis, can mimic metastatic disease or multiple abscesses. Case Presentation. We present the case of a 62-year old former pit worker with pulmonary nodules, chondrocalcinosis due to calcium pyrophosphate deposition (CPPD), and a history of renal cancer. Within a short period of time, pulmonary nodules grew rapidly. Thoracoscopically, the resected lung specimen revealed silicoanthracosis associated with small-to-medium-size vasculitis in the presence of antineutrophil cytoplasmatic autoantibodies (c-ANCA). Conclusion. Pulmonary silicoanthracotic lesions on the base of ANCA-associated vasculitis and CPPD arthritis can rapidly grow. A mutual correlation between silicoanthracosis, ANCA-associated vasculitis, and CPPD seems possible. Apart from this, consideration of metastatic disease should be obligatory in patients with a history of cancer at the same time being immunosuppressed.
authors.affiliation: Division of Thoracic Surgery, University Hospital Zurich, Raemistr. 100, 8091 Zurich, Switzerland.
authors.forename: Wolfgang
authors.identifier: 0000-0002-1442-4862
authors.initials: W
authors.lastname: Jungraithmayr
authors.affiliation: Division of Thoracic Surgery, University Hospital Zurich, Raemistr. 100, 8091 Zurich, Switzerland.
authors.forename: Stefanos
authors.identifier: 0000-0003-3559-2483
authors.initials: S
authors.lastname: Tzafos
authors.affiliation: Department of Rheumatology, University Hospital Zurich, Raemistr. 100, 8091 Zurich, Switzerland.
authors.forename: Oliver
authors.initials: O
authors.lastname: Distler
authors.affiliation: Department of Immunology, University Hospital Zurich, Raemistr. 100, 8091 Zurich, Switzerland.
authors.forename: Antonios G A
authors.initials: AG
authors.lastname: Kolios
authors.affiliation: Division of Thoracic Surgery, University Hospital Zurich, Raemistr. 100, 8091 Zurich, Switzerland.
authors.forename: Walter
authors.initials: W
authors.lastname: Weder
authors.affiliation: Division of Pulmonology, University Hospital Zurich, Raemistr. 100, 8091 Zurich, Switzerland.
authors.forename: Daniel
authors.initials: D
authors.lastname: Franzen
mesh_terms: D000874:Anthracosilicosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D056648:Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001168:Arthritis / Q000150:complications* / Q000188:drug therapy; D002805:Chondrocalcinosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D055613:Multiple Pulmonary Nodules / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D000069283:Rituximab / Q000627:therapeutic use; D013906:Thoracoscopy; D014057:Tomography, X-Ray Computed
chemical_list: D018501:Antirheumatic Agents; D007155:Immunologic Factors; D000069283:Rituximab; D008727:Methotrexate