[Differential diagnosis of berylliosis/sarcoidosis in a dental technician]

Sarcoidosis was diagnosed in a dental technician when he was aged 21 years. Two years later prednisolone treatment was started and continued for 14 years because of nonproductive cough with progressive reduction in vital capacity and CO transfer capacity. Subsequently the risk of exposure to beryllium-containing dust in dental laboratories became known. In his case exposure had started before sarcoidosis had been diagnosed and had continued for 16 years. Changes typical of sarcoidosis (unproductive cough and dyspnoea; bihilar lymphadenopathy and reticulonodular marking in the chest radiogram) were now present, at the age of 40 years.

Vital and diffusion capacities were diminished, serum levels of angiotensin-converting enzyme (141 U/I) and of neopterin (5.8 mg/l) were increased. Beryllium-lymphocyte transformation test of peripheral mononuclear cells after invitro culture with beryllium sulphate gave a raised stimulation index, and the intracutaneous beryllium sensitisation test was positive. This indicated sensitisation to beryllium even 9 years after exposure had ceased.

Even after exposure to beryllium has ended, proof of exposure together with clinical and radiological findings typical of sarcoidosis and beryllium sensitisation can provide the diagnosis of berylliosis.