Acute Respiratory Distress Syndrome Caused by Occupational Exposure to Waterproofing Spray: A Case Report and Literature Review

Abstract

Background: Acute respiratory distress syndrome (ARDS) is a serious respiratory disease, caused by severe infection, trauma, shock, inhalation of harmful gases and poisons and presented with acute-onset and high mortality. Timely and accurate identification will be helpful to the treatment and prognosis of ARDS cases. Herein, we report a case of ARDS caused by occupational exposure to waterproofing spray. To our knowledge, inhalation of waterproofing spray is an uncommon cause of ARDS, and what makes our case special is that we ruled out concurrent infections with some pathogens by using metagenomic next-generation sequencing (mNGS) as an auxiliary diagnosis, which presents the most comprehensive etiological examination of similar reports.

Case presentation: A previously healthy 25 years old delivery man developed hyperpyrexia, chest tightness, cough and expectoration. The symptoms occurred and gradually exacerbated after exposure to a waterproofing spray. The chest computed tomography (CT) finding showed diffuse ground glass and infiltrative shadows in both lungs. The diagnosis of ARDS related to waterproofing spray was established on the basis of comprehensive differential diagnosis and etiological examination. The patient achieved good curative effect after proper systemic glucocorticoid therapy.

Conclusions: The diagnosis and differential diagnosis of acute respiratory failure for outdoor workers, such as delivery drivers or hikers, should be considered whether toxic aerosol exposure exists from daily contacts. The case can educate the public that more attention should be paid to avoid exposure to these chemicals by aerosols/ingestion mode and some preventive strategies should be taken in occupational environment. The treatment effect of glucocorticoids is significant in ARDS patients with general chemical damage caused by inhaling toxic gases and substances.

Keywords: ARDS; case report; glucocorticoids; mNGS; occupational exposure; waterproofing spray.

Figure 1

Changes of chest CT before (A) and after treatment (B), a CT contrast of marked absorption of the lesion after 3 days of treatment. Admission chest X-ray of the patient (C). (A) The chest CT scan demonstrated diffuse ground-glass opacity and infiltrative shadows. (B) After 3 days of using prednisone acetate, the chest HRCT revealed marked absorption of the pulmonary lesions. Red arrows show that the lesions in both lungs were absorbed. (C) Admission Chest X-ray of the patient demonstrated a decreased transparency in both lung field, and there was no signs of cardiomegaly and pleural effusion.

Figure 2

Case history of the patient with ARDS caused by occupational exposure to waterproofing spray. *The blood tests included complete bloodcount, serologic tests (c-reactive protein, procalcitonin, d-dimer); Traditional pathogenic examinations included sputum culture, nucleic acids of respiratory pathogens, sputum smear for acid-fast bacillus, and laboratory investigations of respiratory pathogens serum antibody.