Late-onset damage from occupational asbestos exposure: case report

Our plain-English summary of Late-onset damage from occupational asbestos exposure: case report, by C. Zeroual, M. Benzakour, M. Moudatir, et al (AME Case Reports, 2025).

The study

• Authors: C. Zeroual, M. Benzakour, M. Moudatir, K. Echchilali, S. Mourabit, L. Barakat, H. El Kabli
• Journal: AME Case Reports
• Published: 2025;9:66
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Retroperitoneal fibrosis (RPF), also known as Ormond's disease, is a rare condition characterized by fibrosis in the retroperitoneal space, affecting structures such as the kidneys, ureters, subrenal portion of the abdominal aorta, and the inferior vena cava. While idiopathic RPF is the most common form, it is crucial to rule out secondary causes, which may include certain medications, neoplasms, infections, surgical interventions, or environmental exposures. Prolonged occupational exposure to asbestos is recognized as a rare yet significant cause of RPF.

Case Description: We present the case of a 64-year-old male patient from Casablanca with no notable medical history who reported right low back pain without accompanying fever and exhibited signs of a deteriorating general condition. Clinical examination revealed tenderness upon palpation of the right flank and a left thyroid nodule. Ultimately, a diagnosis of RPF secondary to prolonged occupational asbestos exposure was established. The patient underwent the insertion of a right JJ stent and received combined corticosteroid therapy.

Conclusions: RPF is a chronic condition with management protocols that remain largely undefined, particularly for cases secondary to prolonged occupational asbestos exposure. In benign forms of RPF, corticosteroid therapy serves as the cornerstone of treatment. However, clinicians often find it necessary to incorporate immunosuppressants to prevent frequent relapses associated with tapering or discontinuing corticosteroid therapy. Our initial experience with azathioprine (AZA) has shown promising results.

Copyright © 2025 AME Publishing Company. All rights reserved.

In plain English

This case report described one patient, a 64-year-old man from Casablanca, Morocco, who had worked as an automotive sheet metal worker and had been exposed to asbestos for twenty-five years. The article did not name the type of asbestos fiber. He was admitted with one week of right low back pain and a 6 kg weight loss over the past year. A CT scan showed thickening around the right iliac artery that pressed on the ureter (the tube draining the kidney) and caused moderate swelling upstream. Blood tests showed inflammation. Tests for tuberculosis, IgG4, antinuclear antibodies and tumor markers were negative or normal. No biopsy of the fibrosis was taken. The authors linked his retroperitoneal fibrosis (scarring at the back of the abdomen) to asbestos exposure after excluding other causes. A chest CT showed nodules in both lungs but no pulmonary fibrosis. He received a right ureteral (JJ) stent, corticosteroids and azathioprine. On CT six months after treatment, the fibrous sheath had completely regressed, but mild right kidney dilation remained, with the JJ stent still in place. The authors concluded that azathioprine showed promise.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report of a single patient
• Who was studied: One 64-year-old man from Casablanca, Morocco, treated at the Department of Internal Medicine and Geriatrics, Ibn Rochd University Hospital Center, Casablanca
• Exposure: Occupational asbestos exposure for twenty-five years as an automotive sheet metal worker; fiber type not stated
• Main results:
  • In this patient, CT showed circumferential thickening of the right primary iliac artery wall. It was 17 mm at its maximum thickness and extended over 50 mm, compressing the iliac ureter and causing moderate uretero-hydronephrosis upstream.
  • The patient had an inflammatory syndrome, with a C-reactive protein level of 130.8 mg/L; renal function was preserved
  • In this patient, antinuclear antibody tests were negative and the IgG4 assay was normal. Tumor markers were also normal, and tests for tuberculosis were negative.
  • No biopsy of the retroperitoneal fibrosis was performed in this patient
  • The patient's chest CT showed bilateral lung nodules and micronodules, with no interstitial involvement or pulmonary fibrosis
  • The patient was treated with a right JJ stent and six weeks of full-dose corticosteroids, followed by gradual tapering along with azathioprine at 150 mg per day
  • At the 6-month follow-up CT after treatment, the fibrous sheath around the right primary iliac pedicle had completely regressed
  • At six months, mild right pyelocaliceal dilation persisted, with the JJ stent still in place; no adverse events were reported
• The authors' conclusion: The authors concluded that prolonged asbestos exposure is a significant yet often overlooked cause of retroperitoneal fibrosis, classified as a notifiable occupational disease. They also concluded that immunosuppressants such as azathioprine have shown promise in preventing relapses.

Topics

Medical terms in this study, explained in our Lexicon: Asbestos Exposure, Fibrosis, Idiopathic, Neoplasm, Environmental Exposure, Occupational Exposure.

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