A 45-year-old man, a female quarry worker for 23 years, diagnosed with complicated silicosis (PMF).
He had been an ex-smoker for 10 years of 15 packs/year and pulmonary tuberculosis (PTB) in 2000, being treated correctly with relapse in 2003.
He had required frequent courses of steroids in the last two years.
She came to the Emergency Department due to dyspnea and hemoptoic expectoration of 5 months of evolution.
Physical examination revealed a low-grade fever (37.3oC).
Pulmonary auscultation revealed bilateral snoring and wheezing.
Laboratory tests showed hemoglobin of 11.9 g/l; platelets: 515,000 / mm3; sedimentation rate 79 mm/h and C-reactive protein of 50 mg/l.
Arterial gas showed respiratory failure (pH of 7.45, arterial oxygen pressure of 59 mm Hg and arterial hypertension of 35 mm Hg).
Chest X-ray showed a bilateral micronodular pattern with clusters in both upper lobes.
Computed tomography (CT) revealed extensive bilateral interstitial involvement in relation to complicated silicosis with formation of large masses of progressive massive fibrosis (PMF), which had cavitation within their right lobe not present in a CT scan of 9 months.
Fiberoptic bronchoscopy showed no significant findings and cytology of the bronchoaspirate showed no malignancy.
In sputum, the lowestein culture was negative and culture positive for Aspergillus fumigatus.
A CT scan showed that the cavitated lesion had decreased in size after 7 months of voriconazole treatment.
The patient is currently undergoing evaluation for lung transplantation.
