Ayling-Smith Jonathan, Attanoos Richard, Hutchinson Nicola-Xan
Department of Respiratory Medicine, Cardiff and Vale University Health Board, Cardiff, Wales, UK.
Department of Cellular Pathology, University Hospital of Wales, Cardiff, Wales, UK; School of Medicine, Cardiff University, Cardiff, UK.
Clin Med (Lond). 2025 Jul;25(4):100337. doi: 10.1016/j.clinme.2025.100337. Epub 2025 Jun 8.
Cigarette smoking remains the commonest cause of chronic obstructive pulmonary disease (COPD) and respiratory bronchiolitis-associated interstitial lung disease (RB-ILD). Biomass combustion remains a high risk for causing respiratory disease.
We present a case of a 41-year-old woman and never-smoker with worsening breathlessness. It was identified that she made fire pits burning sage and oils for spiritual work, but beyond this had no respiratory risk factors.
Radiological evidence of RB-ILD was identified and a bronchoscopic lavage demonstrated the presence of striking green pigmented macrophages, presumed to be chlorophyll uptake.
Cessation of burning sage exposure has resulted in a positive outcome. This case highlights the need for an extensive occupational or exposure history in respiratory medicine and describes histological features of interstitial lung disease not previously identified.
吸烟仍然是慢性阻塞性肺疾病（COPD）和呼吸性细支气管炎相关间质性肺病（RB-ILD）最常见的病因。生物质燃烧仍然是导致呼吸系统疾病的高风险因素。
我们报告一例41岁从不吸烟的女性，其呼吸困难症状不断加重。经确认，她为了宗教活动制作燃烧鼠尾草和油的火坑，但除此之外没有其他呼吸系统危险因素。
确诊为RB-ILD的影像学证据，支气管灌洗显示存在大量绿色色素沉着巨噬细胞，推测为叶绿素摄取。
停止接触燃烧的鼠尾草已产生积极效果。该病例强调了呼吸医学中详细职业或暴露史的必要性，并描述了此前未发现的间质性肺病的组织学特征。
