INTRODUCTION: A number of pulmonary pathology have been attributed to aluminum exposure. However, there are only few case reports of aluminum exposure leading to desquamative interstitial pneumonia (DIP). We report the clinical, radiographic, and pathologic finding of a patient who was an aluminum welder with DIP.
CASE PRESENTATION: A 57 year old Caucasian man presents with approximately 2 month history of progressive dyspnea, dry cough, decreased exercise tolerance and hypoxia. He is an ex-smoker, stopped 25 years ago and has 10-pack smoking year history. High resolution computed tomography of chest revealed bilateral ground glass opacities in the upper and mid lung zones. Pulmonary function test revealed moderate restrictive ventilatory defect with severe impairment in gas transfer capacity. Predominant macrophages were seen on bronchoalveolar lavage. Eventual diagnosis of desquamative interstitial pneumonia was diagnosed on open lung biopsy with no evidence of silica or asbestos bodies. Occupational history revealed that he worked as an aluminum grinder for the past 5 years and was exposed to several chemicals including iron and aluminum particles at work. Given iron dust is generally regarded as harmless to the lungs, suspicion therefore fell on the significant amounts to exposure to aluminum dusts. Thorough history and investigation was unremarkable for connective tissue/vasculitis or other environmental exposures. Diagnosis of DIP secondary to significant aluminum dust exposure from grinding and welding was made. There are only 2 reported cases of aluminum exposure resulting in DIP. He continued to deteriorate despite being on steroid and a trial of macrolide antibiotic for DIP. He is currently awaiting lung transplant assessment.
DISCUSSION: Aluminum induced DIP is a rarely reported entity, of which true incidence is unknown. A wide range of pulmonary pathology is attributed to aluminum dust exposure, including interstitial fibrosis, granulomatous disease, pulmonary alveolar proteinosis and few cases of desquamative interstitial pneumonia. Presumed direct/temporal causal relationship is usually assumed. Alveolar macrophages with cytoplasm containing abundant granular pigments have been previously reported in aluminum exposure, which was seen in our patient.
CONCLUSIONS: We conclude that aluminosis is still relevant in occupational medicine and it is pertinent that one obtains comprehensive occupational history in any patients presenting with pulmonary symptoms.
Reference #1 A Hebert et al. Desquamative interstitial pneumonia in an aluminum welder. Human Pathology 13(8):694-9, 1982.
Reference #2 P. Kelleher et al. Inorganic dust pneumonias: The metal-related parenchymal disorders. Environmental Health Perspectives 4(108):685-696, 2000.
Reference #3 J. Mindy et al. Aluminum welding fume-induced pneumoconiosis. Human Pathology 33(8):819-825, 2002.
DISCLOSURE: The following authors have nothing to disclose: Anushya Chelvanathan, Nicole Drost, Jean-Claude Cutz
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