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Haboob Lung Syndrome

Ragesh Panikkath MD, DNB, DMa, Zachary Mulkey MDa, Cynthia Jumper MD, MPHb, Kenneth Nugent MDc

Correspondence to Ragesh Panikkath MD, DNB, DM
Email: ragesh.panikkath@ttuhsc.edu; drrageshp@gmail.com

+ Author Affiliation - Author Affiliation
a a resident in internal medicine at Texas Tech University Health Science Center in Lubbock, TX.
b *8' 2nd one*
c a faculty member in the pulmonary and critical care division at TTUHSC in Lubbock, TX.

SWRCCC : 2013;1.(2):24-25
doi: 10.12746/swrccc2013.0102.018

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Figure 1

Figure 1 Chest X ray of patient showing multilobar infiltrates after exposure to a dust storm. Also seen is the endotracheal tube, a normal cardiothoracic ratio and no pulmonary venous congestion.


There is no medical literature regarding development of acute lung infiltrates/disease after exposure to dust storms except our recent case series.1 However, pneumonia precipitated by dust exposure occurred in the dust bowl era (1930s) in the U.S. A retrospective study from Taipei reported an increased incidence of pneumonia on the days following Asian dust storm events.2 We present an interesting chest X-ray of a 69-year-old healthy white man, a few days after exposure to a massive dust storm.3 (Figure 1) He had presented with severe hypoxia and needed mechanical ventilation with FiO2 of 100% to maintain a PO2 in high 50s. His chest-X ray showed multilobar infiltrates (Figure 2). His blood, sputum, and bronchoalveolar lavage cultures were negative, and he did not respond to empirical broad spectrum antibiotics and antifungals. Legionella antigen, viral studies, and coccidioidomycosis antibody were negative. He expired after a 20 day stormy course in the intensive care unit.


Figure 2

 Figure 2 Picture of a dust storm, similar to the one that this patient was exposed to (Image courtesy - Scott Nolen). A video of the actual storm that the patient was exposed to can be seen using this link - http://youtu.be/wfuDFEZYHTE


We named this presentation Haboob (Arabic for blasting/drafting) Lung Syndrome earlier,1 the components being hypoxemia and multilobar infiltrates after exposure to dust storm. The exact pathogenesis of this syndrome is not clear. Hypersensitivity to dust could be a possible etiology but this patient did not respond to steroids.  A superimposed infection cannot be completely excluded; cultures were negative and the transbronchial biopsy was negative for neutrophils. Prevention seems to be of paramount importance in this condition since the presentation can be severe and life threatening with unclear pathogenesis and treatment options at this time.



References

  1.  Panikkath R, Jumper CA, Mulkey Z. Multilobar lung infiltrates after exposure to dust storm: the haboob lung syndrome. Am J Med. 2013;126:e5-7.
  2.  Kang JH, Keller JJ, Chen CS, Lin HC. Asian dust storm events are associated with an acute increase in pneumonia hospitalization. Ann Epidemiol. 2012;22:257-63.
  3. Dust Storm. wikipedia.com. January 31 2013. http://en.wikipedia.org/wiki/Dust_storm

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Received: 02/04/2013
Accepted: 02/10/2013
Reviewers: Kenneth Nugent MD
Published electronically: 04/15/2013
Conflict of Interest Disclosures: none

 

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