Respiratory failure in a 32-year old farmer due to nitrous dioxide exposure

A 32-year-old, nonsmoking, white farmer was admitted to the hospital on Oct. 1, 1983, in respiratory failure. He had been well until 12 hours prior to admission, at which time he was exposed to a blast of brown, pungent gas as he opened a compartment of his corn silo. After a 10-minute period of unconsciousness and continued exposure to the gas, he was found and brought to medical attention. At that time he was asymptomatic and results of examination were normal, so he was sent home. Ten hours later he became dyspneic and febrile to 38.9°C and returned for medical evaluation. Diffuse rhonchi were audible on chest auscultation, and a chest radiograph showed bilateral alveolar infiltrates. He was hospitalized and within 24 hours required intubation for progressive respiratory failure. Because the clinical picture was consistent with silo-filler's disease, he was treated with high-dose corticosteroids and supportive care. He gradually improved over a five-day period with clearing of his lungs on examination and chest radiograph. Reevaluation at two and eight weeks showed no evidence of clinical disease, including normal chest radiograph and normal results of pulmonary function studies.