A 69-year-old male shows signs of interstitial fibrosis and clubbing. What is most likely in his history?

The presence of interstitial fibrosis and clubbing in a 69-year-old male raises suspicion for a form of pneumoconiosis or interstitial lung disease. Among the provided options, asbestos exposure is most strongly associated with these findings. Asbestos-related diseases, including asbestosis, are characterized by interstitial fibrosis and often present with clubbing of the fingers due to chronic lung injury.

Asbestos fibers can incite an inflammatory response and lead to scarring of lung tissue, which manifests as interstitial fibrosis. This chronic exposure can result in progressive respiratory symptoms and physical findings such as digital clubbing, which is commonly seen in chronic pulmonary conditions with significant lung involvement.

While coal mining and silica exposure can also cause lung disease (coal workers’ pneumoconiosis and silicosis, respectively), they have different clinical and radiographic presentations and are less commonly associated with clubbing compared to asbestosis.

Textile work also typically does not relate to interstitial fibrosis or clubbing, unless specific hazardous materials were involved, but this is much less common.

Therefore, the history most likely pointing to interstitial fibrosis and clubbing in this patient is asbestos exposure.