Desquamative interstitial pneumonia associated with chrysotile asbestos fibres

Our plain-English summary of Desquamative interstitial pneumonia associated with chrysotile asbestos fibres, by J.A. Freed, A. Miller, R.E. Gordon, et al (British Journal of Industrial Medicine, 1991).

The study

• Authors: J.A. Freed, A. Miller, R.E. Gordon, A. Fischbein, J. Kleinerman, A.M. Langer
• Journal: British Journal of Industrial Medicine
• Published: 1991;48(5):332-7
• Type of article: Case report
• Cited by: 12 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 004157).

Abstract

The drywall construction trade has in the past been associated with exposure to airborne asbestos fibres. This paper reports a drywall construction worker with 32 years of dust exposure who developed dyspnoea and diminished diffusing capacity, and showed diffuse irregular opacities on chest radiography. He did not respond to treatment with corticosteroids. Open lung biopsy examination showed desquamative interstitial pneumonia. Only a single ferruginous body was seen on frozen section, but tissue examination by electron microscopy showed an extraordinary pulmonary burden of mineral dust with especially high concentrations of chrysotile asbestos fibres. This report emphasises the need to consider asbestos fibre as an agent in the aetiology of desquamative interstitial pneumonia. The coexistent slight interstitial fibrosis present in this case is also considered to have resulted from exposure to mineral dust, particularly ultramicroscopic asbestos fibres.

In plain English

This was a case report of one man who worked in drywall construction for 32 years. That work exposed him to components of taping and jointing compounds. He was first seen at Mount Sinai Hospital, New York, in August 1985, aged 52, with three months of breathlessness. Chest x-rays showed fine interstitial opacities in both lungs and no pleural abnormalities. An open lung biopsy showed desquamative interstitial pneumonia (DIP), with air spaces packed with large macrophages and mild interstitial fibrosis. Only a single asbestos body was seen on frozen section. Electron microscopy, however, found about 819 million chrysotile fibres and about 20 million tremolite fibres (probably cleavage fragments) per gram of dry lung. About 90% of the chrysotile fibres were shorter than 5 micrometres. An earlier bronchoscopic biopsy found no common asbestos fibres; the report noted its small size limited any conclusions about inorganic agents. Prednisone considerably cleared the x-ray but did not change his symptoms or lung function. The authors concluded that asbestos should be considered one of the agents in the cause of DIP in this case.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: One male drywall construction worker, first evaluated at Mount Sinai Hospital, New York, on 7 August 1985 at age 52 for shortness of breath (dyspnoea) of three months' duration
• Exposure: 32 years of drywall construction work with exposure to components of taping and jointing compounds; lung tissue analysis found chrysotile asbestos and tremolite
• Main results:
  • Open lung biopsy of the patient showed desquamative interstitial pneumonia, with alveolar spaces packed with large macrophages
  • The open lung biopsy also showed mild interstitial fibrosis
  • Electron microscopy of digested lung tissue found about 819 x 10^6 chrysotile fibres per gram of dry lung and about 20 x 10^6 tremolite fibres (probably cleavage fragments) per gram of dry lung
  • About 90% of the chrysotile fibres in the patient's lung were shorter than 5 micrometres
  • Chrysotile fibres about 3 micrometres long were seen inside the macrophages
  • Only one asbestos body was seen on frozen section of the open lung biopsy; a digested-tissue count gave 4666 asbestos bodies per gram of wet tissue
  • The chrysotile fibres were too small to be seen with light microscopy
  • The earlier bronchoscopic biopsy found quartz and probably fibrous talc, but none of the common asbestos fibres
  • The patient's chest radiograph was coded S/P, 1/2 on the International Labour Office scale, with no pleural abnormalities
  • Prednisone (40 mg/day) produced considerable clearing on the chest radiograph but no change in the patient's respiratory symptoms or abnormal lung function
• The authors' conclusion: The authors concluded that asbestos should be considered as one of the agents in the cause of this case of DIP
• Limitations the authors state:
  • The small size of the bronchoscopic biopsy specimen limited any conclusions about inorganic agents drawn from it
  • The authors considered the fibre count conservative, because clumps of chrysotile fibrils were counted as single fibres

Topics

The National Library of Medicine indexes this study under subjects our site covers: Chrysotile.

Medical terms in this study, explained in our Lexicon: Interstitial, Chrysotile, Diffusing Capacity (DLCO), Biopsy, Ferruginous body, Frozen Section, Interstitial Fibrosis.

Related studies

• Electron microscopic studies in desquamative interstitial pneumonia associated with asbestos — B. Corrin, A.B. Price (1972)
• Desquamative interstitial pneumonitis. Cellular phase of fibrosing alveolitis — R.R. Tubbs, S.P. Benjamin, et al. (1977)
• Desquamative interstitial pneumonia induced by metal exposure. A case report and literature review — T. Blin, A. De Muret, et al. (2020)
• Biphasic malignant mesothelioma with epithelioid and sarcomatoid components (dedifferentiated mesothelioma) and intrapulmonary growth: a rare entity mimicking desquamative interstitial pneumonia — J. Laforga, A. Gonzalez Garcia (2020)
• Imatinib mesylate inhibits fibrogenesis in asbestos-induced interstitial pneumonia — K. Vuorinen, F. Gao, et al. (2007)
• Agreement between chest radiography and high-resolution computed tomography in diagnosing dust-related interstitial lung fibrosis — R.R. Tiwari (2015)

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