Acute respiratory decompensation revealing occupational baritosis: A case report

Baritosis is a rare pneumoconiosis caused by chronic inhalation of barium sulfate dust and is traditionally considered a benign condition characterized mainly by radiological abnormalities and minimal functional impairment. However, prolonged exposure may lead to severe respiratory failure and cor pulmonale. We report the case of a 73-year-old man with a history of prolonged occupational exposure to barite and heavy smoking who presented with progressive dyspnea and acute respiratory deterioration. Clinical examination revealed hypoxemic respiratory failure and digital clubbing. Chest computed tomography demonstrated diffuse bilateral micronodular opacities with high attenuation consistent with pneumoconiosis. Arterial blood gas analysis showed hypercapnic respiratory failure. Transthoracic echocardiography revealed pulmonary hypertension with right ventricular dysfunction compatible with cor pulmonale. The patient was managed with oxygen therapy, bronchodilators, diuretics, corticosteroids, and empiric antibiotic therapy. This case challenges the traditional concept of baritosis as a purely benign pneumoconiosis and highlights its potential progression to clinically significant interstitial lung disease with pulmonary hypertension and right heart failure. Baritosis was suspected in an appropriate occupational context, namely the occupational history which remains essential for diagnosis.