Silo Filler's Lung (Nitrogen Dioxide-Induced Pulmonary Disease)

 

Synonym: silo filler's disease

 

Risk factors:

(1) failure to wear respiratory protection when working in a silo

(2) failure to adequately ventilate a silo before entering

(3) exposure to decomposing silage or vegetation, especially if nitrogen rich

 

Clinical features:

(1) one or more risk factors

(2) onset of respiratory failure with impaired gas exchange, hyaline membranes and pulmonary edema

(3) lung biopsy shows nonspecific interstitial fibrosis

(4) exclusion of other causes (infection, hypersensitivity pneumonitis, etc)

 

Early diagnosis with initiation of therapy (corticosteroids, other) can improve outcomes. Steroids may need to be given for 8 or more weeks.