Anthracosilicosis

Anthracosilicosis is very rarely described in the medical literature and the term was created as a combination of two separate disorders [1] [2]:

• Anthracosis - Defined as the accumulation of carbon in the lungs as a result of exposure to significant amounts of coal dust or smoke in heavily polluted areas or in the industrial setting, anthracosis is primarily an asymptomatic condition resulting in black discoloration of the lungs [1] [3] [4]. However, cough and dyspnea, particularly after substantial deposition of carbon, are described as potential symptoms [3] [4].
• Silicosis - Being one of the most severe forms of occupational lung disease due to its life-threatening risk in the absence of an early diagnosis and early prevention, silicosis stems from inhalation of crystalline silica [5]. Mining, stone cutting, quarrying, cement manufacturing and stone, clay or glass industries are industries where workers can inhale significant concentrations of this mineral [4]. Symptoms such as dyspnea, breathlessness, and cough may appear acutely (within weeks or months) when very high amounts are inhaled, or after years of persistent occupational exposure [4] [5].

Consequently, the clinical presentation of dyspnea, cough, and breathlessness is typically seen, but reports also show that melanoptysis (black-pigmented sputum) and chest pain might also be present [1].

Regardless of the type of occupational or environmental lung disease, a detailed patient history, and a thorough physical examination are the first and most important steps in the workup. Chronic respiratory complaints must prompt the physicians to obtain information about the patient's occupation and daily exposure to air pollution, which has been confirmed as a possible cause of anthracosilicosis [1]. Lung auscultation may reveal wheezing, and along with symptoms of cough, dyspnea or breathlessness, is sufficient evidence to look for an underlying cause through lung function tests and imaging studies. In most cases, an obstructive pattern of impaired lung function is observed at spirometry [1] [4] [5]. On the other hand, plain radiography is a useful initial method for assessment, as non-homogeneous pulmonary infiltrates and reticulonodular opacities are typical for anthracosis and anthracosilicosis [1] [3], whereas calcified hilar nodes producing an "eggshell" pattern is typical for silicosis [4]. High-resolution computed tomography (HRCT), however, is a superior imaging procedure compared to chest X-rays and is recommended whenever possible due to its ability to visualize the exact site of the nodules and identify the extent and nature of the opacities [1] [4]. Finally, bronchoscopy may be implemented as a definite diagnostic measure, showing the abundance of anthracotic pigments and the presence of birefringent particles on polarized light microscopy, the main hallmarks of anthracosis and silicosis, respectively [1].

1. Spalgais S, Gothi D, Jaiswal A, Gupta K. Nonoccupational anthracofibrosis/anthracosilicosis from Ladakh in Jammu and Kashmir, India: A case series. Indian J Occup Environ Med. 2015;19(3):159-166.
2. Vanhoenacker FM, Van den Brande P, De Schepper AM. Hepatosplenic antracosilicosis: a rare cause of splenic calcifications. Eur Radiol. 2001;11(7):1184-1186.
3. Mirsadraee M. Anthracosis of the Lungs: Etiology, Clinical Manifestations and Diagnosis: A Review. Tanaffos. 2014;13(4):1-13.
4. Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson J, Loscalzo J. eds. Harrison's Principles of Internal Medicine, 18e. New York, NY: McGraw-Hill; 2012.
5. Mazurek JM, Schleiff PL, Wood JM, Hendricks SA, Weston A; Centers for Disease Control and Prevention (CDC). Notes from the Field: Update: Silicosis Mortality - United States, 1999-2013. MMWR Morb Mortal Wkly Rep. 2015;64(23):653-654.