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Abstract: TH-PO562

Unique Case of Silicosis Leading to Several Autoimmunities: Rheumatoid Arthritis and Membranous Lupus Nephritis

Session Information

Category: Glomerular Diseases

  • 1401 Glomerular Diseases: From Inflammation to Fibrosis

Authors

  • Potruch, Assaf, Hadassah University Medical Center, Jerusalem, Jerusalem, Israel
  • Abbasi, Momen, Hadassah University Medical Center, Jerusalem, Jerusalem, Israel
  • Hershko Moshe, Anat A., Hadassah University Medical Center, Jerusalem, Jerusalem, Israel
  • Abel, Roy, Hadassah University Medical Center, Jerusalem, Jerusalem, Israel
Introduction

Silicosis is a fibrotic lung disease caused by the inhalation of free crystalline silica, and is the oldest pulmonary occupational hazard known. Silica exposure has been linked to several other conditions including infections, malignancies and autoimmunity.

Case Description

A 41-year-old male, marble factory worker, lung silicosis diagnosed by biopsy on 2012. ANA, dsDNA, anti-Smith and RF were all negative than.
in 2017 due to symmetrical arthritis and newly positive RF rheumatoid arthritis was diagnosed, and he was treated with steroids, hydroxychloroquine and methotrexate.
Patient currently presented with arthralgia, peripheral edema, and almost 10 Kg gain during a month. He was not taking any medical treatment at that time.
lab results indicated normal renal function, a low serum albumin (23g/L), and nephrotic range proteinuria (7.4 g/g). ANA, anti-Smith, anti-SSA were positive, and C3 was low.
Renal biopsy revealed rigid glomerular capillary walls with tiny discreate deposits in the outer aspect of the GBM, a “full house” pattern immunofluorescence, and increased mesangial matrix (M) with numerous electron dense deposits, intramembranous (IM) and subepithelial deposits (SE) interposition of glomerular basement membrane material (spikes), and effacement of foot processes (P) were seen at EM(figure), compatible with membranous pattern injury of SLE. Patient received steroids hydroxychloroquine and MMF treatment.

Discussion

Silicosis is associated with impaired immune system, high risk for pulmonary infections malignancies and more. It is also associated with inflammatory diseases such as RA, scleroderma and mixed connective tissue disease.
Autoantibodies as anti-DNA and anti-SSA/B occur in a higher frequency in individuals exposed to silica than general population. Renal involvement secondary to silica has been seen in the past, however this is the first description of membranous lupus nephritis after silica exposure.