Rheumatoid pneumoconiosis (Caplan's syndrome) in an asbestos worker

Our plain-English summary of Rheumatoid pneumoconiosis (Caplan's syndrome) in an asbestos worker, by W.G. Tellesson (Thorax, 1961).

The study

• Author: W.G. Tellesson
• Journal: Thorax
• Published: 1961;16(4):372-7
• Type of article: Case report
• Cited by: 18 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 002626).

Abstract

A case of Caplan's syndrome in an asbestos worker is described. It differs from the first reported case of this association in the radiographic findings, namely, large cavitated nodules of unilateral distribution, in the absence of the classical features of pulmonary asbestosis, and in the late development of rheumatoid arthritis.

PubMed has no abstract for this study. This is the authors' abstract, copied from the article.

In plain English

This article was a case report of one 39-year-old man from Sydney, Australia. From 1942 to 1957 he had worked in a Sydney factory making asbestos-cement sheets and mouldings, where amosite, chrysotile and crocidolite were used. In 1959, after a chest infection, X-rays showed large cavitated lesions in his right lung. They showed no features typical of asbestosis, and he had no symptoms of rheumatoid arthritis. A factory survey X-ray from June 1953 had been normal. Surgeons removed the masses. A frozen section was reported as non-malignant, and no organisms were detected. Under the microscope the lung showed diffuse dense fibrosis, nodules matching the pattern of rheumatoid pneumoconiosis (Caplan's syndrome), and asbestosis bodies. A new nodule later appeared. By December 1960 he had a swollen finger joint and a positive Rose-Waaler test. The author described this as the second reported case of rheumatoid pneumoconiosis associated with asbestosis. The author suggested that the unexpected fibrosis may reflect an abnormal response to asbestos in lung tissue altered by the rheumatoid state.

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 39-year-old man who had worked with asbestos, seen at Randwick Chest Hospital, Sydney, Australia, in 1959 to 1960
• Exposure: 15 years (1942 to 1957) in a Sydney factory making asbestos-cement sheets and mouldings. Amosite, chrysotile and crocidolite were used. He spent seven years on moulding and the rest in the store handling bagged dry fibre. His estimated average exposure was 0.3 million particles per cubic foot, and his cumulative exposure at the time of the 1953 survey was thought not to exceed 4 million particle-years per cubic foot.
• Main results:
  • Chest X-rays showed large cavitated lesions in the right lung without features typical of asbestosis
  • A chest X-ray from the June 1953 factory survey had been within normal limits; the lesions were not present then
  • A frozen section of the upper lobe lesion was reported as non-malignant
  • The removed lung tissue showed diffuse dense fibrosis
  • Asbestosis bodies were present among clumps of macrophages
  • The nodular lesions closely matched the typical microscopic pattern of rheumatoid pneumoconiosis
  • At presentation the patient had no symptoms or signs of rheumatoid arthritis
  • Later, a new right lung nodule grew to 1.5 x 2.5 cm. By December 1960 the patient had swelling of a finger joint and a positive Rose-Waaler test.
• The authors' conclusion: The author concluded that this was a second example of rheumatoid pneumoconiosis associated with asbestosis. It differed from the first reported case in three ways: large unilateral cavitated nodules, no classical features of pulmonary asbestosis, and rheumatoid arthritis developing later. The author suggested that the extensive, unexpected fibrosis may be due to an abnormal response to asbestos in tissues altered by, or predisposed to, the rheumatoid state.
• Limitations the authors state:
  • The author stated that there was no direct evidence of how long the lung lesions had been present
  • The author stated that why the visible lesions were confined to one lung could not be answered

Topics

The National Library of Medicine indexes this study under subjects our site covers: Asbestosis.

Medical terms in this study, explained in our Lexicon: Pneumoconiosis, Asbestosis.

Related studies

• Rheumatoid "pneumoconiosis" (Caplan's syndrome) in an asbestos worker: a 17 years' follow-up — I.A. Greaves (1979)
• Rheumatoid lung changes associated with asbestosis — A.G. Rickards, G.M. Barrett (1958)
• Rheumatoid pneumoconiosis in association with asbestosis — W.K. Morgan (1964)
• Occupations and exposures in the work environment as determinants for rheumatoid arthritis — A.R. Olsson, T. Skogh, et al. (2004)
• Association of Agricultural, Occupational, and Military Inhalants With Autoantibodies and Disease Features in US Veterans With Rheumatoid Arthritis — A.V. Ebel, G. Lutt, et al. (2021)
• Investigative techniques in the laboratory study of coal workers' pneumoconiosis: recent advances at the cellular level — J.S. Harington (1972)

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