Two cases of hard metal lung disease showing gradual improvement in pulmonary function after avoiding dust exposure
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CASE REPORT
Open Access
Two cases of hard metal lung disease showing gradual improvement in pulmonary function after avoiding dust exposure Hiroya Terui1, Satoshi Konno1*, Kichizo Kaga2, Yoshihiro Matsuno3, Kanako C. Hatanaka3, Hiromi Kanno3, Hiroshi Moriyama4, Motohiro Uo5 and Masaharu Nishimura1
Abstract We present herein two cases of hard metal lung disease (HMLD) with distinct pathological findings. Both cases showed gradual improvements in pulmonary function over a period of a few years (Case 1: 30 months; Case 2: 12 months) after the avoidance of dust exposure, while improvements on high-resolution computed tomography were modest. The increased lymphocytes and decreased CD4/CD8 ratio in BALF observed at initial diagnosis normalized after the avoidance of dust exposure in one case. To the best of our knowledge, this is the first report demonstrating continual follow-up of pulmonary function and radiographic findings, and a comparison of BALF findings before and after avoidance of hard metal dust exposure. Keywords: Hard metal lung disease, Pulmonary function, Dust exposure, Avoidance, BALF
Background Hard metal lung disease (HMLD) is a rare occupational lung disease that can occur in workers engaged in the manufacture, utilization, or maintenance of tools composed of hard metal, a synthetic compound composed of tungsten carbide and cobalt [1, 2]. Although giant cell interstitial pneumonitis (GIP) is known as a typical pathological finding for this disease [3–5], some cases without GIP have also been reported [6, 7]. The clinical course of this disease varies, with some cases requiring corticosteroid treatment and others showing spontaneous improvement simply by avoiding exposure to hard metal [5, 8–12]. We report two cases of HMLD with distinct pathological findings: one as typical GIP; and the other characterized by peribronchial fibrosis without typical features of GIP. Continual follow-up of pulmonary function and radiological findings as well as comparisons of bronchoalveolar lavage fluid (BALF) findings before and after dust exposure were obtained.
* Correspondence: [email protected] 1 First Department of Medicine, Hokkaido University School of Medicine, Kita-15 Nishi-7 Kita-Ku, Sapporo, Hokkaido 060-8638, Japan Full list of author information is available at the end of the article
Case presentation Case 1
A 50-year-old non-smoking woman presented with a 6-month history of nonproductive cough, which had started 8 years after she began working with a hard metal grinder without using a dust protective mask. High-resolution computed tomography (HRCT) of the chest showed diffuse centrilobular micronodular opacities and curved linear shadows in the dorsum (Fig. 1a). Pulmonary function test results were almost within normal levels for vital capacity (VC) (2.20 L; percentage predicted VC (%VC), 86.6 %), forced expiratory volume in 1 s (FEV1) (2.07 L; percentage predicted FEV1 (%FEV1), 95.4 %), total lung capacity (TLC) (3.33 L; percent predicted TLC (%TLC), 87.2 %), and diffusing capacity of the
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