PMC9428916_01
The patient's helmet, showing a lot of brown dust both outside (A) and inside (B). (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
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He had been properly using a dust-proof mask while working, but a large amount of welding fumes had been generated two weeks prior to the visit, clogging the dust filter after half a day and causing the patient's helmet to turn brown (Fig. 1).
Chest radiography on admission, showing diffuse reticulonodular abnormalities in both lung fields (A). Chest computed tomography on admission showing multiple centrilobular small nodules and ground-glass appearances in both lungs (B).
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Chest radiography and computed tomography (CT) showed diffuse small nodules and ground-glass opacities in both lungs (Fig. 2), and bronchoalveolar lavage revealed bloody fluid (Fig. 3) with an abundance of hemosiderin-laden alveolar macrophages.
Chest computed tomography showing improvement on day 44 (A) and further improvement on day 460 (B).
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However, despite improvement in his chest CT findings (Fig. 4A), he remained smoke-free but still had persistent hypoxemia and a decreased respiratory function after a month and a half, requiring home oxygen therapy to manage (Fig. 5). CT more than a year later showed further improvement to simply pale micronodules (Fig. 4B).
A clinical course of the patient. %FVC; forced vital capacity, % predicted, %FEV1; forced expiratory volume in 1 sec, % predicted.
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Although nintedanib treatment was discontinued due to liver dysfunction two months after the initiation, the patient was eventually weaned from home oxygen therapy after a total of six months (Fig. 5).