A 45-year-old male with silicosis developed a large pericardial effusion with fluid cytology concerning for silica birefringence, ultimately requiring pericardiocentesis and a pericardial window.
Case Report (n=1)
This case highlights the potential for silica exposure to cause widespread inflammation, including silica-driven pericarditis with large pericardial effusion.
Abstract Introduction Silicosis is a lung parenchyma disease due to the accumulation of crystalline silica particles commonly seen in characteristic occupations. It is commonly associated with cardiovascular complications such as arrhythmia, constrictive pericarditis, and pulmonary hypertension. We present a rare case complicated with pericardial effusion, miliary lung micronodules, mediastinal and abdominal lymphadenopathy. Case Presentation This is a 45-year-old male who worked as a stone cutter with a history of coccidiomycosis and silicosis presenting with worsening cough. Vital signs showed T 37.6, HR 131, SpO2 97% on room air, BP 151/93, RR 18. He was given 1 L IV fluid and 1 dose of antibiotics. EKG showed sinus tachycardia (ST) at 132 beats per minutes. CT chest with IV contrast showed miliary pattern of micronodules with focal consolidation in bilateral perihilar regions, moderate to large pericardial effusion (Fig 1), lymphadenopathy within the mediastinum and visualized abdomen. Transthoracic echocardiogram (TTE) demonstrated a large pericardial effusion with focal strands, without tamponade physiology. Initial laboratory workup demonstrated elevated ESR 119, CRP 167, platelets 466,000, and negative AFB, QuantiFERON and coccidiomycosis antibodies. Cardiology recommended trial of diuresis with IV furosemide 40mg and colchicine 0.6 mg twice daily. Repeat TTE showed no change in the pericardial effusion size and persistent ST in the 130s, so he underwent pericardiocentesis and was transferred to the ICU after placement of the pericardial drain. The fluid studies showed WBC 3676, RBC 1,712,000, lymphocytic predominance, LDH 2000, glucose 102 and protein 6.4. Autoimmune workup showed C3 205, normal C4, and negative ANA, RF, Anti CCP, Anti dsDNA, Anti streptolysin O, Anti DNase B and Anti Scleroderma. Blood and sputum cultures were negative. Fluid culture was positive for scant Cuti bacterium acnes and cytology concerning for silica birefringence. Repeat TTE showed persistent moderate sized pericardial effusion without tamponade physiology. Given persistently limited output from the pericardial drain, he was transferred to another facility and underwent a pericardial window. Discussion Silica may not be confined to the lungs but can act as a catalyst of widespread inflammation. Linking pericardial involvement to silica provides rare evidence of silica-driven pericarditis and expands the boundaries of this occupational disease. As industrial workers continue to be exposed to high-burden silica environments, there is both a clinical lesson and a call to action: to heighten diagnostic vigilance, to reconsider screening for systemic involvement, and to pursue research into targeted immunomodulatory therapies to reduce silica-associated complications. This abstract is funded by: none
Khan et al. (Fri,) conducted a case report in Silicosis with pericardial effusion (n=1). Furosemide, colchicine, pericardiocentesis, and pericardial window was evaluated. A 45-year-old male with silicosis developed a large pericardial effusion with fluid cytology concerning for silica birefringence, ultimately requiring pericardiocentesis and a pericardial window.
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