Combined asthma and alveolitis induced by cobalt in a diamond polisher

A diamond polisher presented with a history of dyspnea, chest tightness, chills and weight loss related to exposure to diamond cobalt disks at work. Pulmonary function showed slightly reduced lung volumes, low normal diffusing capacity and a moderate bronchial hyperresponsiveness to histamine. Chest X-ray and cell count in bronchoalveolar lavage fluid were normal. After 3 months of non-exposure, a bronchial cobalt challenge test caused an immediate decrease in specific airway conductance and in vital capacity (VC) but not in FEV1/VC. After 6 h, chills, fever, tachycardia and crackles appeared along with moderate reductions in lung volumes. After 24 h, the bronchoalveolar lavage fluid showed 43% granulocytes, and there was a marked increase in bronchial hyperresponsiveness to histamine. These changes are interpreted as combined asthma and alveolitis induced by cobalt.