Abstract Anthracosis usually presents with chronic dyspnea and cough and is most often associated with chronic biomass smoke exposure rather than tobacco use. Formerly referred to as “hut lung,” domestically acquired particulate lung disease results from prolonged indoor exposure to smoke from wood, charcoal, or animal dung. Its presentation can mimic infectious or malignant processes, making recognition dependent on a detailed exposure history. A 71-year-old woman presented to the emergency department with two weeks of progressive shortness of breath, cough, and mid-chest discomfort radiating to the back. She denied fever or sick contacts. CTA chest showed persistent bulky bilateral hilar adenopathy with worsening pulmonary artery stenosis. She was referred to pulmonology after being flagged in a lung nodule database. Her history included asthma, treated latent tuberculosis, and no smoking history. Born in Afghanistan and later living in Pakistan, she reported frequent indoor cooking with wood, charcoal, and animal dung before immigrating to the United States in 2017. She endorsed long-standing exertional dyspnea, fatigue, and poor appetite.Bronchoscopy with EBUS-TBNA and BAL revealed anthracotic airways and enlarged lymph nodes. Cytology was negative for malignancy, and cultures were negative. Histopathology demonstrated pigmented macrophages, consistent with anthracosis. Findings, combined with exposure history, supported a diagnosis of biomass-associated lung disease.She presented again to the ED and subsequently admitted for worsening dyspnea, treated empirically for possible pneumonia, which improved with corticosteroids and bronchodilators. She was discharged on a steroid taper with clinical improvement. This case demonstrates biomass-associated anthracosis in a non-smoking immigrant woman, highlighting the importance of environmental history in unexplained dyspnea and hilar adenopathy. The disease can closely resemble tuberculosis, sarcoidosis, or malignancy, often requiring tissue confirmation. Recognition is essential, as management focuses on eliminating exposure and symptom control rather than antimicrobial or oncologic therapy.As global migration increases, clinicians in high-income countries should remain aware of hut lung/DAPLD and other environmentally acquired particulate lung diseases in patients from regions where biomass fuel use is prevalent. This abstract is funded by: None
Wolff et al. (Fri,) studied this question.