Danger Dust - What Else?

After discussion between nephrology, rheumatology, infectious disease, and pulmonology, he was admitted for expedited kidney biopsy and bronchoscopy.

Kidney biopsy revealed glomerulonephritis with 30% active crescents and both IgG and C3 deposition, not entirely typical for lupus or ANCA vasculitis but concerning for druginduced or infection-associated ANCA.

Bronchoscopy showed hemosiderin ladenmacrophages but BAL was inconsistent with diffuse alveolar hemorrhage and negative for tuberculosis through AFB stain and culture.

Since his quantiferon was positive and he had immigrated from a TB-endemic region, concern for miliary tuberculosis was high, so he underwent VATS lung biopsy which was consistent with silicosis based on pathology demonstrating nodular aggregates of dust-laden macrophages, fibrosis, and birefringent particles. A diagnosis of ANCA vasculitis associated with silicosis was made.