Some sage advice: A case report of sage burning causing interstitial lung disease

Background: Cigarette smoking remains the commonest cause of chronic obstructive pulmonary disease (COPD) and respiratory bronchiolitis-associated interstitial lung disease (RB-ILD). Biomass combustion remains a high risk for causing respiratory disease. Method: We present a case of a 41-year-old wo...

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Bibliographic Details
Main Authors: Jonathan Ayling-Smith, Richard Attanoos, Nicola-Xan Hutchinson
Format: Article
Language:English
Published: Elsevier 2025-07-01
Series:Clinical Medicine
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Online Access:http://www.sciencedirect.com/science/article/pii/S1470211825000557
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Summary:Background: Cigarette smoking remains the commonest cause of chronic obstructive pulmonary disease (COPD) and respiratory bronchiolitis-associated interstitial lung disease (RB-ILD). Biomass combustion remains a high risk for causing respiratory disease. Method: We present a case of a 41-year-old woman and never-smoker with worsening breathlessness. It was identified that she made fire pits burning sage and oils for spiritual work, but beyond this had no respiratory risk factors. Results: Radiological evidence of RB-ILD was identified and a bronchoscopic lavage demonstrated the presence of striking green pigmented macrophages, presumed to be chlorophyll uptake. Conclusions: Cessation of burning sage exposure has resulted in a positive outcome. This case highlights the need for an extensive occupational or exposure history in respiratory medicine and describes histological features of interstitial lung disease not previously identified.
ISSN:1470-2118