Chronic beryllium disease in identical twins

Identical male twins born in 1959 have developed chronic beryllium disease. Twin 1 was exposed to beryllium for more than 3 years. The diagnosis was first suspected at the time of his post-employment chest radiograph. Twin 2 was exposed for 21 months and ceased employment at the same time as his brother. His post-employment examination was normal. Thirty months later he developed an unusual skin rash which biopsy showed to be granulomatous. Further investigations proved the diagnosis. Both men have reduced tear secretion measured with Schirmer's test, a feature not previously reported in this condition. Bronchoalveolar lavage and laser microprobe mass spectrometry (LAMMS) were used as aids to the diagnosis. Sarcoidosis has been reported in identical twins, suggesting genetic susceptibility, which may also be of importance in chronic beryllium disease.