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Breathing dust can trigger Wegener’s granulomatosis too

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Doctors would do well to remember that dust exposure can trigger Wegener’s granulomatosis, as a case of Wegener’s granulomatosis with chronic rhinosinusitis has shown.

The case was in a 54 year old man who presented with chronic nasal symptoms and crusting and bloody inflammation lasting eight years. Over 20 years before he had worked for 15 years as a carpenter, when he had suffered with constant nose pain; soreness; bloody nasal discharge; and chronic obstruction when planing wood, stripping paint, and doing tasks generating dust. He had never worn a mask. He had been a heavy smoker but had not used cocaine.

Clinical examination and follow up tests plus a nasal biopsy showed a strong positive reaction to antineutrophil cytoplasmic antibodies (ANCA) and histological evidence of chronic inflammation of the nasal mucosa and around the vessel walls with necrosis, indicating Wegener’s granulomatosis.

The symptoms almost all resolved after a year of oral steroid and trimethoprim-sulphamethoxazole with four intravenous cyclophosphamide pulses every four weeks.

Carpenters have an increased risk of chronic respiratory diseases, sinusitis, and sinus cancers, which can occur decades after original exposure to the trigger. This patient had 10 years before presented with chronic rhinosinusitis and presented again with recurrence of symptoms. A decline in woodworking means that dust exposure may easily be overlooked—recent publications fail to mention such exposure as an environmental trigger for Wegener’s granulomatosis.

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