Desquamative interstitial pneumonia induced by metal exposure. A case report and literature review.
Adrenal Cortex Hormones
/ administration & dosage
Aluminum
/ adverse effects
Biopsy
Granuloma, Respiratory Tract
/ chemically induced
Humans
Inhalation Exposure
/ adverse effects
Lung
/ chemistry
Lung Diseases, Interstitial
/ chemically induced
Male
Middle Aged
Treatment Outcome
Zirconium
/ adverse effects
Aluminium lung
Interstitial lung disease
Metal analysis
Zirconium lung
desquamative interstitial pneumonia
Journal
Sarcoidosis, vasculitis, and diffuse lung diseases : official journal of WASOG
ISSN: 2532-179X
Titre abrégé: Sarcoidosis Vasc Diffuse Lung Dis
Pays: Italy
ID NLM: 9610928
Informations de publication
Date de publication:
2020
2020
Historique:
received:
16
12
2019
accepted:
07
02
2020
entrez:
23
10
2020
pubmed:
24
10
2020
medline:
4
11
2020
Statut:
ppublish
Résumé
Forms of interstitial pneumonia secondary to exposure to an air-contaminant are varied and so far, insufficiently described. We report here a case of a 57-year-old patient managed in our department for the exploration of MRC grade 2 dyspnoea and interstitial pneumonia. He mentioned multiple occupational and domestic exposures such as hens' excrements, asbestos and metal particles; he also had a previous history of smoking. High-resolution computed tomography showed ground glass opacities predominating in posterior territories and surrounding cystic lesions or emphysematous destruction. The entire etiological assessment revealed only macrophagic alveolitis with giant multinucleated cells on the bronchoalveolar lavage. A surgical lung biopsy allowed us to refine the diagnosis with evidence of desquamative interstitial pneumonia and pulmonary granulomatosis. Finally, the analysis of the mineral particles in the biopsy revealed abnormally high rates of Zirconium and Aluminium. We were therefore able to conclude to a desquamative interstitial pneumonia associated with pulmonary granulomatosis linked to metal exposure (Aluminium and Zirconium). The clinical, functional and radiological evolution was favorable after a systemic corticosteroid treatment with progressive decay over one year. This presentation reports the first case to our knowledge of desquamative interstitial pneumonitis related to exposure to Zirconium and the third one in the context of Aluminium exposure. The detailed analysis of the mineral particles present on the surgical lung biopsy allows for the identification of the relevant particle to refine the etiological diagnosis, to guide the therapeutic management and to give access to recognition as an occupational disease.
Sections du résumé
BACKGROUND
BACKGROUND
Forms of interstitial pneumonia secondary to exposure to an air-contaminant are varied and so far, insufficiently described.
OBJECTIVES/METHODS
OBJECTIVE
We report here a case of a 57-year-old patient managed in our department for the exploration of MRC grade 2 dyspnoea and interstitial pneumonia. He mentioned multiple occupational and domestic exposures such as hens' excrements, asbestos and metal particles; he also had a previous history of smoking.
RESULTS
RESULTS
High-resolution computed tomography showed ground glass opacities predominating in posterior territories and surrounding cystic lesions or emphysematous destruction. The entire etiological assessment revealed only macrophagic alveolitis with giant multinucleated cells on the bronchoalveolar lavage. A surgical lung biopsy allowed us to refine the diagnosis with evidence of desquamative interstitial pneumonia and pulmonary granulomatosis. Finally, the analysis of the mineral particles in the biopsy revealed abnormally high rates of Zirconium and Aluminium. We were therefore able to conclude to a desquamative interstitial pneumonia associated with pulmonary granulomatosis linked to metal exposure (Aluminium and Zirconium). The clinical, functional and radiological evolution was favorable after a systemic corticosteroid treatment with progressive decay over one year.
CONCLUSION
CONCLUSIONS
This presentation reports the first case to our knowledge of desquamative interstitial pneumonitis related to exposure to Zirconium and the third one in the context of Aluminium exposure. The detailed analysis of the mineral particles present on the surgical lung biopsy allows for the identification of the relevant particle to refine the etiological diagnosis, to guide the therapeutic management and to give access to recognition as an occupational disease.
Identifiants
pubmed: 33093772
doi: 10.36141/svdld.v37i1.9103
pii: SVDLD-37-79
pmc: PMC7569535
doi:
Substances chimiques
Adrenal Cortex Hormones
0
Zirconium
C6V6S92N3C
Aluminum
CPD4NFA903
Types de publication
Case Reports
Journal Article
Review
Langues
eng
Pagination
79-84Informations de copyright
Copyright: © 2020 SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES.
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