A care report demonstrating the need for a simple but most import history taking

초록

Introduction: Anthracosis or black lung disease is considered a type of pneumoconiosis, a lung condition that occurs when inhaled coal or carbon particles are deposited in the lungs. It is characterized by the deposition of black or gray carbon-laden particles visible upon examination of lung tissue or sputum samples and can be seen as dark discoloration. Case report: A 82-year-old man came to the hospital due to one day of fever and dyspnea. He was diagnosed with idiopathic pulmonary fibrosis (IPF) in August 2022 and has a history of hospitalization for acute exacerbations of IPF in January and March 2023. The patient worked in a coal mine for railroad maintenance, for approximately five years, about 20 years ago. He complained of a persistent productive cough and anthracoid-colored sputum. On chest CT scan, a honeycombing pattern was observed with internal calcification and mass-like lesions with low attenuation in both upper lobes. Compared to the previous chest CT, there was an increase in consolidation and progression of the honeycombing pattern. A lung tissue biopsy was not performed, but sputum and BAL fluid cytology were done. BAL cytology showed a significant presence of coal dust and findings of pneumonia, characterized by neutrophils, lymphocytes, and histiocytes within degenerated cell clusters. Plant materials with cell walls surrounded by anthracotic pigment were identified. GMS stain showed a negative finding, so we ruled out the fungal infection. Therefore, he was diagnosed as anthracosis and acute exacerbation of IPF due to aspiration pneumonia. After confirming the diagnosis, the patient was treated with antibiotics and oral prednisolone and his symptoms were improved. Discussion: We report a case that reminds us of the importance of simple but essential history-taking.