Anthracofibrosis Presenting as Middle Lobe Syndrome in a Patient With Difficult-to-Treat Asthma: A Case Report

Abstract

Background: Middle lobe syndrome (MLS) is characterized by recurrent or persistent collapse of the right middle lobe, secondary to bronchial obstruction. Anthracofibrosis (AF), which can cause bronchial stenosis through anthracotic pigment deposition and fibrosis, may produce this obstruction and mimic refractory asthma. Objective: To describe a case of MLS secondary to AF in a patient with difficult-to-treat asthma.

Case report: A 69-year-old man who had never smoked and lived in a rural area; with a history of poorly controlled asthma, multiple exacerbations, and persistent middle lobe (ML) atelectasis. The CT showed atelectasis and traction bronchiectasis. Flexible bronchos copy (FBC) revealed marked stenosis of the ML bronchus with architectural distortion. Due to a poor response to medical management, a video-assisted thoracoscopic surgery (VATS) middle lobectomy was performed. Pathologic findings revealed nodal anthracosis. Conclusion: AF should be included in the differential diagnosis of MLS and difficult-to treat asthma in patients with chronic biomass smoke exposure or those residing in rural areas.