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Original Research: OCCUPATIONAL AND ENVIRONMENTAL LUNG DISEASES |

Indium Lung DiseaseIndium Lung Disease

Kristin J. Cummings, MD, MPH; Makiko Nakano, MD, DMSc; Kazuyuki Omae, MD, DMSc; Koichiro Takeuchi, MD; Tatsuya Chonan, MD, PhD; Yong-long Xiao, MD; Russell A. Harley, MD; Victor L. Roggli, MD, FCCP; Akira Hebisawa, MD, PhD; Robert J. Tallaksen, MD; Bruce C. Trapnell, MD; Gregory A. Day, PhD; Rena Saito, PhD; Marcia L. Stanton, BS; Eva Suarthana, MD, PhD; Kathleen Kreiss, MD
Author and Funding Information

From the Division of Respiratory Disease Studies (Drs Cummings, Day, Saito, Suarthana, Kreiss and Ms Stanton), National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV; Department of Preventive Medicine and Public Health (Drs Nakano and Omae), Keio University School of Medicine, Tokyo, Japan; Occupational Respiratory Disease Center (Dr Takeuchi), Toyama Rosai Hospital, Toyama, Japan; Department of Medicine (Dr Chonan), Nikko Memorial Hospital, Hitachi, Japan; Department of Respiratory Medicine (Dr Xiao), Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China; Department of Pathology and Laboratory Medicine (Dr Harley), Medical University of South Carolina, Charleston, SC; Department of Pathology (Dr Roggli), Duke University Medical Center, Durham, NC; Department of Pathology (Dr Hebisawa), Tokyo National Hospital, Tokyo, Japan; Department of Radiology (Dr Tallaksen), West Virginia University School of Medicine, Morgantown, WV; Division of Pulmonary, Critical Care, and Sleep Medicine (Dr Trapnell), University of Cincinnati College of Medicine, Cincinnati, OH; and Epidemic Intelligence Service (Dr Suarthana), Centers for Disease Control and Prevention, Atlanta, GA.

Correspondence: Kristin J. Cummings, MD, MPH, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, 1095 Willowdale Rd, MS 2800, Morgantown, WV 26505; e-mail: kcummings@cdc.gov


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

Funding/Support: This work was supported by intramural funding from the National Institute for Occupational Safety and Health, Centers for Diseases Control and Prevention. Dr Trapnell is supported by the National Institutes of Health [Grant NIH R01 HL085453].


© 2012 American College of Chest Physicians


Chest. 2012;141(6):1512-1521. doi:10.1378/chest.11-1880
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Background:  Reports of pulmonary fibrosis, emphysema, and, more recently, pulmonary alveolar proteinosis (PAP) in indium workers suggested that workplace exposure to indium compounds caused several different lung diseases.

Methods:  To better understand the pathogenesis and natural history of indium lung disease, a detailed, systematic, multidisciplinary analysis of clinical, histopathologic, radiologic, and epidemiologic data for all reported cases and workplaces was undertaken.

Results:  Ten men (median age, 35 years) who produced, used, or reclaimed indium compounds were diagnosed with interstitial lung disease 4-13 years after first exposure (n = 7) or PAP 1-2 years after first exposure (n = 3). Common pulmonary histopathologic features in these patients included intraalveolar exudate typical of alveolar proteinosis (n = 9), cholesterol clefts and granulomas (n = 10), and fibrosis (n = 9). Two patients with interstitial lung disease had pneumothoraces. Lung disease progressed following cessation of exposure in most patients and was fatal in two. Radiographic data revealed that two patients with PAP subsequently developed fibrosis and one also developed emphysematous changes. Epidemiologic investigations demonstrated the potential for exposure to respirable particles and an excess of lung abnormalities among coworkers.

Conclusions:  Occupational exposure to indium compounds was associated with PAP, cholesterol ester crystals and granulomas, pulmonary fibrosis, emphysema, and pneumothoraces. The available evidence suggests exposure to indium compounds causes a novel lung disease that may begin with PAP and progress to include fibrosis and emphysema, and, in some cases, premature death. Prospective studies are needed to better define the natural history and prognosis of this emerging lung disease and identify effective prevention strategies.

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