Environmental Asbestos Exposure as a Possible Pathway to Early-Onset Pleural Mesothelioma: A Case From Afghanistan and Pakistan to London.

Malignant pleural mesothelioma (MPM) is strongly associated with occupational asbestos exposure and typically presents decades after exposure, in older men. The association of MPM with environmental exposure and genetic susceptibility is less recognised. We report a case of a 40-year-old man presenting in London with dyspnoea, weight loss and a persistent right-sided pleural effusion following hospitalisation for pneumonia. Imaging showed circumferential nodular thickening of the right pleura with lymph node involvement, and histopathology was in keeping with epithelioid-type MPM. With no known occupational exposure, childhood residences in Kabul, Afghanistan and Peshawar, Pakistan, where high levels of environmental asbestos are documented, represent plausible sources of environmental exposure. As a result of migration from regions with high environmental asbestos exposure, clinicians in high-income countries may encounter increasing numbers of patients with MPM due to non-occupational asbestos exposure.