Solitary lung nodule with possible occupational origin in a patient admitted for musculoskeletal complaints - case presentation and review of literature concerning exposure in rubber industry

Abstract This case report illustrates the critical necessity of detailed occupational history no matter the chief symptom for the hospital admittance. If any exposure to carcinogens has been noticed, the target organ of the identified hazard(s) should be screened for cancer. We present a case of a 51-year-old male admitted for musculoskeletal complaints in which the occupational history revealed exposure to carcinogens and the chest X-ray showed a solitary pulmonary nodule (SPN). The patient, a current smoker with a 22.5 pack-year index, had a significant past occupational exposure, having worked in a rubber manufacturing company as a vulcanizer/wringer for approximately ten years (1991–2002). Given the patient’s smoking history and exposure to chemical carcinogens in the rubber industry – classified as a Group 1 carcinogen by IARC – lung cancer screening was initiated. A chest X-ray and subsequent CT scan confirmed an 11mm solitary nodule in the left upper lobe. Based on standard clinical risk models, the nodule’s malignancy probability was estimated between 7.42% and 13.5%, classifying the case as intermediate risk (Lung-RADS Category 4B). Further diagnostic efforts, including bronchoscopy and bronchoalveolar lavage, yielded only a benign cytology with an acute nonspecific inflammatory appearance. Given the intermediate risk profile and occupational background, the patient will be followed according to the Fleischner Society 2017 guidelines, starting with a repeated CT scan in 3 months. The case underscores that an occupational etiology for lung cancer is highly probable, even in a smoking patient, and emphasizes that occupational factors must be considered significant in etiology, even long after exposure has ceased.