Pleural vasculitides of microscopic polyangiitis with asbestos-related plaques

Our plain-English summary of Pleural vasculitides of microscopic polyangiitis with asbestos-related plaques, by A. Hara, Y. Kinoshita, K. Hosoi, et al (Respirology Case Reports, 2015).

The study

• Authors: A. Hara, Y. Kinoshita, K. Hosoi, Y. Okumura, M. Song, K. Min
• Journal: Respirology Case Reports
• Published: 2015;3(4):148-50
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

A 69-year-old man who had been exposed to asbestos for approximately 40 years presented with the complaint of fever and pleuritic chest pain on the right side on deep inspiration. Chest X-ray films showed pleural effusion in the right side. Initial antibiotic treatment was ineffective. The hyaluronic acid level was high in the pleural effusion but no malignant mesotheliomal cells were seen with blind pleural biopsy. Blood chemistry showed a remarkable high titer of myeloperoxidase anti-neutrophil cytoplasmic antibody (MPO-ANCA) and open renal biopsy suggested crescentic glomerulonephritis. The precise pathological examination on the pleura obtained by the open pleural biopsy showed vasculitides and plaque leading to diagnosis of microscopic polyangiitis (MPA). This is a rare case of MPA seen in the pleural arteries.

In plain English

This case report from Itami City Hospital in Japan described one 69-year-old man who had worked as an air conditioning pipe fitter and had been exposed to asbestos for about 40 years. The article did not name the asbestos fiber type. The patient had fever and right-sided chest pain, with fluid around the right lung and, a month later, the left. An antibiotic helped only briefly. The pleural fluid had a high hyaluronic acid level (123,000 ng/ml), which the authors noted suggested mesothelioma. However, tissue taken by thoracoscopic surgery showed no signs of mesothelioma. Scans suggested pleural plaques. A blood antibody test (MPO-ANCA) was strongly positive, and a kidney biopsy showed crescent formations in some glomeruli. The pleural tissue showed inflamed small blood vessels, and the patient was diagnosed with microscopic polyangiitis, a form of vasculitis. After high-dose prednisolone, the fluid almost disappeared. The authors suggested the asbestos exposure may have contributed. They concluded that, although very uncommon, vasculitis should be considered in asbestos-exposed patients with pleural effusion once all other more common causes are excluded. The report describes one patient only.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: One 69-year-old man seen at Itami City Hospital, Japan; dates of care not given
• Exposure: Occupational asbestos exposure for approximately 40 years as an air conditioning pipe fitter; fiber type and dose not stated
• Main results:
  • Pleural effusion first appeared on the right side and appeared on the left side one month later
  • Fever and CRP improved immediately on antibiotic treatment, but after a few days the inflammation returned
  • Hyaluronic acid in the patient's pleural fluid was high at 123,000 ng/ml; no bacterium was cultured
  • Contrast-enhanced HRCT suggested thick parietal pleura and pleural plaques
  • Pleural tissue obtained by video-assisted thoracoscopic surgery showed no signs of mesothelioma
  • MPO-ANCA was strongly positive (>300 U/ml), and serum creatinine rose from 0.81 to 1.14 in one month
  • The open renal biopsy contained 15 glomeruli, some with crescent formations
  • The pleural specimens showed clusters of neutrophils around the venules and capillaries of the pleura, and the patient was diagnosed with microscopic polyangiitis (MPA)
  • The case was first classified as probable MPA and, after the pleural and kidney pathology, reclassified as definitive MPA
  • After high-dose prednisolone (1 mg/kg/day), the pleural effusion almost disappeared
  • The authors interpreted the patient's asbestos exposure as an environmental risk factor that may have contributed to the disease
• The authors' conclusion: The authors concluded that, although very uncommon, pleural effusion in a patient with known asbestos exposure should raise the possibility of vasculitis in the differential diagnosis once all other more common causes have been excluded

Topics

Medical terms in this study, explained in our Lexicon: Pleuritic Chest Pain, Chest X-Ray, Pleural Effusion, Hyaluronic Acid, Pleural Biopsy, Biopsy, Pleura.

Related studies

• Malignant mesothelioma not related to asbestos exposure: Analytical scanning electron microscopic analysis of 83 cases and comparison with 442 asbestos-related cases — A. Kraynie, G.G. de Ridder, et al. (2016)
• Occupational Exposures and Smoking in Eosinophilic Granulomatosis With Polyangiitis: A Case-Control Study — F. Maritati, F. Peyronel, et al. (2021)
• Asbestos-related pleural plaques and lung function — L.C. Oliver, E.A. Eisen, et al. (1988)
• Do asbestos-related pleural plaques on HRCT scans cause restrictive impairment in the absence of pulmonary fibrosis? — B. Clin, C. Paris, et al. (2011)
• Asbestos-related pleural plaques and lung cancer — W. Weiss (1993)
• Asbestos-related lesions of the pleura: parietal plaques compared to diffuse thickening studied with chest roentgenography, computed tomography, lung function, and gas exchange — G. Hillerdal, P. Malmberg, et al. (1990)

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