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Small Airway-Centered Granulomatosis Caused by Long-term Exposure to PolytetrafluoroethylenePolytetrafluoroethylene-Induced Lung Granulomatosis

Won-Il Choi, MD, PhD; Hye Ra Jung, MD; Esmeralda Shehu, MD; Byung Hak Rho, MD; Mi-Young Lee, MD, PhD; Kun Young Kwon, MD, PhD
Author and Funding Information

From the Department of Internal Medicine (Drs Choi and Shehu) and Department of Pathology (Drs Jung and Kwon), Keimyung University School of Medicine, Daegu, South Korea; Department of Internal Medicine (Dr Shehu), Regional Hospital of Durres, Durres, Albania; and Department of Radiology (Dr Rho) and Preventive Medicine (Dr Lee), Keimyung University School of Medicine, Daegu, South Korea.

Correspondence to: Mi-Young Lee, MD, PhD, Department of Preventive Medicine, Keimyung University School of Medicine, 1095 Dalgubeol-daero, Daegu 704-701, South Korea; e-mail: mylee@dsmc.or.kr


Drs Choi and Jung contributed equally to this work.

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


Chest. 2014;145(6):1397-1402. doi:10.1378/chest.13-1997
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To date, there have been no reports of chronic pulmonary granulomatosis associated with exposure to polytetrafluoroethylene (PTFE). Here, we report three cases of small airway-centered granulomatous lesions in workers employed at facilities that apply coatings to pans and other utensils. The workers were repeatedly exposed to PTFE particles that were probably generated by the drying process when PTFE coatings are dried in a convection oven at high temperatures (380-420°C). The duration of inhalational PTFE exposure was between 7 and 20 years. We found granulomatous lung lesions around the small airways in lung biopsy specimens obtained from the workers. Scanning electron microscopy/energy-dispersive x-ray spectroscopy analysis was performed focusing on areas where the PTFE particles were suspected to be located in macrophages. The scanning electron microscopy/energy-dispersive x-ray spectroscopy analyses revealed fluorine in the particles. Lung tissue samples from all cases were analyzed using a fully automated Fourier transform infrared spectrometer. Analysis of the spectrum extracted from the position of the foreign particles enabled precise identification of the foreign bodies as PTFE. Fourier transform infrared revealed that all of the lung tissue samples had bands at 1,202 to 1,148 cm−1 and 1,202 to 1,146 cm−1, which are characteristic of the asymmetric and symmetric stretching vibrations of the C-F bonds of PTFE. These cases suggest that recurrent inhalational exposure to PTFE particles causes chronic pulmonary granulomatosis.

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