Pseudomediastinal fibrosis caused by massive lymphadenopathy in domestically acquired particulate lung disease

Abstract

In this report, we describe a case of domestically acquired particulate lung disease (DAPLD) or “hut lung” in a 59-year-old woman of Moroccan descent who emigrated to the Netherlands, having lived in an rural area for most her life. She presented with obstructive lung disease and with signs of mediastinal fibrosis which were shown to be caused by massive enlargement of mediastinal lymph nodes. To the best of our knowledge, this is the first case of DAPLD from Morocco and the first report of a case of DAPLD mimicking mediastinal fibrosis.

Introduction

“Hut lung” or domestically acquired particulate lung disease (DAPLD) is a severe anthracosis with fibrosis, which may be diagnosed by histopathological examination of lung tissue from a nonsmoker with significant environmental exposure to biomass smoke and without occupational inorganic dust exposure [1], [2]. Biomass smoke originates from fires fueled with wood, dung, straw, or corn husks, or may be produced in the process of charcoal production [2].

Biomass-fueled stoves are predominantly used in underdeveloped countries in or around enclosed living quarters like huts. Domestically acquired particulate lung disease cases have been reported from Africa, the Americas, Asia, and Australia [2]. This condition has a wide range of clinical presentations; it may be discovered incidentally but, on the other hand, may cause pulmonary obstructive disease and rarely pulmonary fibrosis or cor pulmonale [1], [2], [3], [4]. Increased immigration from underdeveloped nations results in a higher incidence of the DAPLD in developed countries.

Mediastinal fibrosis (MF) is a progressive fibrosclerotic disease, which may be caused by histoplasma or mycobacterial infection in some cases [5], [6], [7], [8], [9], [10], [11]. However, in most cases of MF, the cause is unknown. Enlargement of mediastinal lymph nodes may mimic MF with compression of large blood vessels and airways. We present a case of DAPLD as an imported disease in the Netherlands from Morocco caused by long-term food preparation over a wood-fired stove. Mediastinal fibrosis was suggested in view of the massive mediastinal lymphadenopathy.