CRRT experience in a patient diagnosed with anthracofibrosis in intensive care : a case report

Bronchial anthracofibrosis is a condition characterized by dark pigmentation (anthracosis) in the bronchial mucosa, often accompanied by bronchial stenosis or obstruction due to fibrosis in the same area. Diagnosis is frequently established by bronchoscopy in patients who do not fully respond to treatment, show radiological abnormalities, and have obstructive lung disease. When looking at the literature on anthracofibrosis, it is mostly seen in conjunction with tuberculosis, but it can also frequently accompany pneumonia, therefore necessitating close monitoring. In intensive care unit (ICU), continuous renal replacement therapy (CRRT) is one of the frequently used treatment methods in critically ill patients with acute kidney injury (AKI) due to sepsis. It is particularly preferred in patients with acute renal failure (ARF) who have hemodynamic instability and are using inotropic agents. Our case is a 78-year-old male patient who was admitted to ICU due to pneumonia secondary to sepsis, septic shock, and AKI. During his follow-ups in ICU, due to frequent airway obstructions, a bronchoscopy was performed, and a diagnosis of anthracofibrosis was made. CRRT was planned as he was hypotensive and anuric under the support of inotropic agents. However, both the Disseminated Intravascular Coagulation picture due to sepsis that occurred in the patient and intrabronchial hemorrhages-clot plugs, as well as obstruction in the airway and increase in airway pressure due to anthracofibrosis were observed. The increase in airway pressure could not be performed for a long time as it increased the hemodynamic instability for CRRT. With this case report, it is intended to emphasize the effects of an increase in airway pressure on CRRT. In cases of obstructive lung diseases that do not respond to bronchodilators, such as anthracofibrosis, it should be kept in mind that the increase in airway pressure can cause more hemodynamic instability, especially in critically ill patients, and measures should be taken to reduce airway pressure