Rheumatoid "pneumoconiosis" (Caplan's syndrome) in an asbestos worker: a 17 years' follow-up

Our plain-English summary of Rheumatoid "pneumoconiosis" (Caplan's syndrome) in an asbestos worker: a 17 years' follow-up, by I.A. Greaves (Thorax, 1979).

The study

• Author: I.A. Greaves
• Journal: Thorax
• Published: 1979;34(3):404-5
• Type of article: Case report
• Cited by: 10 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. 002078).

Summary of the article

This report described the later clinical course and necropsy findings of a man first reported by Tellesson in 1961 as having rheumatoid pneumoconiosis (Caplan's syndrome) related to asbestos exposure. In 1959 the patient, then 39, had worked for 15 years in an asbestos cement factory. He had no further asbestos exposure after 1957. Chest radiographs showed lung nodules. These were resected at thoracotomy in June 1959 and showed histology considered typical of rheumatoid pneumoconiosis, with asbestos bodies within the nodules and interstitial fibrosis. Rheumatoid arthritis, absent at thoracotomy, developed within 12 months. Further nodules appeared in both lungs, some cavitating, with no new lesions after 1964. Corticosteroid treatment in 1962 was followed by severe infection and lifelong chronic sputum production. Pleural calcification increased over time. He later developed splenomegaly, neutropenia, anaemia, leg ulcers, thyrotoxicosis, several circulating autoantibodies, and renal impairment. He died suddenly in 1976 after a myocardial infarction. At necropsy the pleura was thickened, fibrosed and calcified, and both lungs contained nodules 0.5 to 5 cm in diameter. Occasional ferruginous fragments but no typical asbestos bodies were seen, and there was no diffuse fibrosis attributable to asbestosis. The author concluded that asbestos exposure was possibly of little importance in the development of the nodules. He suggested that the patient's multiple immune-related diseases might indicate an intrinsic susceptibility to immune-mediated lung disease irrespective of asbestos exposure.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This case report described the later illness and necropsy of a man Tellesson reported in 1961 as having rheumatoid pneumoconiosis (Caplan's syndrome). He had worked for 15 years in an asbestos cement factory. In 1959, at age 39, he had lung nodules removed; asbestos bodies were seen within them, and fibrosis in the lung between them. He had no further asbestos exposure after 1957. Rheumatoid arthritis developed within 12 months. From December 1962 he had a severe lung infection, then lifelong chronic sputum and repeated infections. More nodules appeared in the right lung, then by 1961 in the left, with a later fresh crop on the left; none appeared after 1964. Pleural calcification grew more prominent over time. He later developed several other conditions, most associated, the author wrote, with disturbances of immune function. He died suddenly in 1976, months after a heart attack. At necropsy the nodules held occasional ferruginous fragments but no typical asbestos bodies. No diffuse fibrosis attributable to asbestosis was found. The author concluded that his illnesses might suggest an intrinsic susceptibility to immune-mediated lung disease irrespective of asbestos exposure.

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 (follow-up and necropsy of a previously reported patient)
• Who was studied: one man, aged 39 in 1959, in Australia, first reported by Tellesson in 1961 and followed until his death in 1976
• Exposure: 15 years of work in an asbestos cement factory, with no further asbestos exposure after 1957; fiber type not stated
• Main results:
  • At surgery in 1959, asbestos bodies were seen within the resected lung nodules
  • Rheumatoid arthritis, absent at the time of surgery, developed within 12 months
  • In December 1962, during corticosteroid treatment for a flare of arthritis, a severe lung infection developed; chronic sputum production with repeated infections persisted for the rest of his life
  • Further nodules developed in the rest of the right lung and, by September 1961, in the left lung
  • A later fresh crop of nodules appeared in the left lung, but no new lesions appeared after 1964
  • Calcification of the pleura became more prominent over time
  • He later developed thyroid and other autoantibodies among several other conditions
  • He had an extensive heart attack in February 1976 and died suddenly in June
  • At necropsy, only occasional ferruginous fragments and no typical asbestos bodies were seen within the nodules
  • At necropsy, the lung between nodules showed no diffuse fibrosis attributable to asbestosis; the interstitial fibrosis noted in 1959 was not found 17 years later
• The authors' conclusion: The author concluded that asbestos exposure was possibly of little importance in the development of this patient's lung nodules, and that his many immune-related diseases might suggest an intrinsic susceptibility to immune-mediated lung disease irrespective of asbestos exposure

Topics

Medical terms in this study, explained in our Lexicon: Pneumoconiosis, Autopsy, Asbestos Exposure, Asbestos-Cement, Chest X-Ray, Thoracotomy, Histology, Asbestos Bodies.

Related studies

• Rheumatoid pneumoconiosis (Caplan's syndrome) in an asbestos worker — W.G. Tellesson (1961)
• Rheumatoid pneumoconiosis in association with asbestosis — W.K. Morgan (1964)
• Lung and pleural CT signs predict deaths: 10-year follow-up after lung cancer screening of asbestos-exposed workers — T. Vehmas, P. Oksa, et al. (2012)
• All-cause and cause specific mortality in a cohort of 20 000 construction workers; results from a 10 year follow up — V. Arndt, D. Rothenbacher, et al. (2004)
• Mortality among workers exposed to asbestos at the shipyard of Genoa, Italy: a 55 years follow-up — D.F. Merlo, M. Bruzzone, et al. (2018)
• Lung function predicts mortality: 10-year follow-up after lung cancer screening among asbestos-exposed workers — T. Vehmas, P. Pallasaho, et al. (2013)

Browse more research in Thorax, or return to medical research.