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Imaging Features of Systemic Sclerosis-Associated Interstitial Lung Disease
Published on: June 16, 2020
Desquamative interstitial pneumonia induced by metal exposure. A case report and literature review
Timothée Blin1,2, Anne De Muret3, Marion Teulier1
1Service de Pneumologie et d'explorations fonctionnelles respiratoires, CHU Bretonneau, Tours, France.
Background:
Forms of interstitial pneumonia secondary to exposure to an air-contaminant are varied and so far, insufficiently described.
Objectives/Methods:
We report here a case of a 57-year-old patient managed in our department for the exploration of MRC grade 2 dyspnoea and interstitial pneumonia. He mentioned multiple occupational and domestic exposures such as hens' excrements, asbestos and metal particles; he also had a previous history of smoking.
Results:
High-resolution computed tomography showed ground glass opacities predominating in posterior territories and surrounding cystic lesions or emphysematous destruction. The entire etiological assessment revealed only macrophagic alveolitis with giant multinucleated cells on the bronchoalveolar lavage. A surgical lung biopsy allowed us to refine the diagnosis with evidence of desquamative interstitial pneumonia and pulmonary granulomatosis. Finally, the analysis of the mineral particles in the biopsy revealed abnormally high rates of Zirconium and Aluminium. We were therefore able to conclude to a desquamative interstitial pneumonia associated with pulmonary granulomatosis linked to metal exposure (Aluminium and Zirconium). The clinical, functional and radiological evolution was favorable after a systemic corticosteroid treatment with progressive decay over one year.
Conclusion:
This presentation reports the first case to our knowledge of desquamative interstitial pneumonitis related to exposure to Zirconium and the third one in the context of Aluminium exposure. The detailed analysis of the mineral particles present on the surgical lung biopsy allows for the identification of the relevant particle to refine the etiological diagnosis, to guide the therapeutic management and to give access to recognition as an occupational disease. (Sarcoidosis Vasc Diffuse Lung Dis 2020; 37 (1): 79-84).
Insights
This case study identifies desquamative interstitial pneumonia and pulmonary granulomatosis linked to occupational exposure to aluminum and zirconium. Treatment with corticosteroids led to a favorable clinical outcome.
Area of Science:
- Pulmonary Medicine
- Occupational Health
- Toxicology
Background:
- Interstitial pneumonias from air contaminant exposure are diverse and poorly understood.
- Occupational exposures, including asbestos, metal particles, and animal excrement, can contribute to lung disease.
Observation:
- A 57-year-old male presented with dyspnea and interstitial pneumonia, reporting significant occupational and domestic exposures.
- High-resolution CT revealed ground-glass opacities and cystic lesions, predominantly in posterior lung regions.
Findings:
- Bronchoalveolar lavage showed macrophagic alveolitis with multinucleated giant cells.
- Surgical lung biopsy confirmed desquamative interstitial pneumonia and pulmonary granulomatosis.
- Analysis revealed elevated levels of Zirconium and Aluminium particles in the lung biopsy.
Implications:
- This is the first reported case of desquamative interstitial pneumonitis linked to Zirconium exposure and the third associated with Aluminium exposure.
- Mineral particle analysis in lung biopsies is crucial for accurate etiological diagnosis and guiding treatment for occupational lung diseases.
- Identifying specific metal exposures aids in therapeutic management and facilitates occupational disease recognition.
