A57-12 Acute Inhalational Lung Injury From Occupational Phosphine Exposure in a 23-Year-Old Male

Abstract Introduction Phosphine gas exposure is a rare but serious occupational hazard often used as a fumigant or flame retardant. Phosphine is a colorless and odorless gas, although the commercial grade form typically has a fishy odor. Phosphine can cause respiratory, cardiovascular, liver, and kidney failure with significant exposure. We present a case of phosphine-associated inflammatory bronchiolitis with clear radiologic evolution from injury to recovery. Case Description A 23-year-old HVAC technician with a history of exercise-induced asthma presented with dyspnea and pleuritic chest pain after 3-5 hours of occupational exposure to a foul-smelling gas while not wearing a mask. The gas was later identified as phosphine. Chest X-ray on admission revealed bilateral airspace opacities. Computed tomography (CT) of the chest demonstrated diffuse centrilobular ground-glass nodules, most prominent in the posterior inferior right upper lobe, consistent with inflammatory bronchiolitis secondary to toxic gas inhalation. The patient remained hemodynamically stable and was managed conservatively with as-needed bronchodilators. He did not require supplemental oxygen. Follow-up chest X-ray on hospital day 3 showed improving infiltrates. At outpatient follow-up 10 days post-exposure, the patient had fully recovered and was asymptomatic. Discussion While phosphine is a common industrial gas, there are few case reports of inhalation injury secondary to phosphine exposure. This case demonstrates typical imaging findings of inflammatory bronchiolitis seen in inhalation injuries. While significant phosphine exposure can cause severe lung injury and multiorgan involvement, this patient had rapid symptomatic and radiographic improvement in just 3 days. Figure 1 From left to right: Chest X-ray Day 1, CT of the chest on day 1 showing centrilobular ground glass nodules, Repeat chest X-ray on day 3 This abstract is funded by: None