Acute respiratory distress in a silversmith.

Area of Science:

• Occupational Medicine
• Toxicology
• Pulmonary Medicine

Background:

• A 25-year-old non-smoker presented with severe respiratory distress, dry cough, and chest pain.
• Initial assessment revealed significant hypoxemia (oxygen saturation 28%) and a PaO2/FiO2 ratio of 100, suggestive of Acute Respiratory Distress Syndrome (ARDS).

Observation:

• The patient, a goldsmith, reported increased exposure to golden yellow fumes while smelting silver adulterated with cadmium.
• Physical examination showed reduced breath sounds, rhonchi, crepitations, and central cyanosis.
• Chest X-ray revealed bilateral fluffy opacities consistent with non-cardiac pulmonary edema.

Findings:

• The patient's symptoms and diagnostic findings strongly indicated cadmium fume inhalation as the cause of ARDS.
• Serum cadmium levels were elevated at 2.9 μg/L six days post-exposure.
• He required mechanical ventilation for 10 days and showed residual lung opacities at discharge.

Implications:

• This case highlights cadmium fume inhalation as a potential occupational hazard causing severe ARDS.
• Early recognition of occupational exposure is critical for diagnosing and managing such cases.
• Protective measures for workers in metal smelting industries are essential to prevent toxic exposures.