Desquamative interstitial pneumonia induced by metal exposure. A case report and literature review

Our plain-English summary of Desquamative interstitial pneumonia induced by metal exposure. A case report and literature review, by T. Blin, A. De Muret, M. Teulier, et al (Sarcoidosis, Vasculitis, and Diffuse Lung Diseases, 2020).

The study

• Authors: T. Blin, A. De Muret, M. Teulier, M. Ferreira, M. Vincent, M. Catinon, A. Legras, P. Diot, S. Marchand-Adam
• Journal: Sarcoidosis, Vasculitis, and Diffuse Lung Diseases
• Published: 2020;37(1):79-84
• Type of article: Case report, Review
• Cited by: 9 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

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).

Copyright: © 2020 SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES.

In plain English

This article was a case report with a short literature review. It described a 57-year-old man hospitalized in 2017 in Tours, France, for breathlessness and interstitial pneumonia, a disease of the lung tissue. He had worked as a plumber exposed to asbestos, then in a foundry with possible exposure to metals including aluminium and zirconium. He had also cleaned hens' excrement, welded and ground as hobbies, and had a 30 pack-year smoking history. A surgical lung biopsy showed desquamative interstitial pneumonia with granulomas. Particle analysis of the biopsy found higher shares of zirconium compounds (5.2% versus 0.0%), aluminium compounds (4.4% versus 0.05%) and steel (14.0% versus 0.6%) than in a reference group from the Forensic Institute of Lyon. The reported particle results concerned metals, not asbestos. After corticosteroid treatment, his breathing tests and scans improved at one year. The authors concluded that the disease was secondary to metal exposure (aluminium, zirconium compound and steel). They described it as, to their knowledge, the first such case linked to zirconium.

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 of one patient, with a review of published cases
• Who was studied: One 57-year-old man hospitalized in 2017 in a pulmonology department at CHU Bretonneau, Tours, France
• Exposure: Past work as a plumber with asbestos exposure, then foundry work with possible exposure to alloys of copper, bronze, iron, aluminium and zirconium compounds. He also had domestic exposure to hens' excrement for 5 years, welding and grinding hobbies, and a 30 pack-year smoking history (stopped 10 years earlier).
• Main results:
  • The surgical lung biopsy (left lower lobe) showed desquamative interstitial pneumonitis, with emphysema lesions and numerous giant-epithelioid granulomas without necrosis
  • Zirconium compounds made up 5.2% of particles in the patient's biopsy, versus 0.0% in the reference population
  • Aluminium compounds made up 4.4% in the patient, versus 0.05% in the reference population
  • Aluminium oxide made up 2.0% versus 0.2%, and steel 14.0% versus 0.6%, in the patient versus the reference population
  • The reference population was 53 blocks of lung tissue from the forensic institute of Lyon, with 4050 particles analysed
  • The test for bird fancier's precipitins (an allergy to bird droppings) was negative, including for hens' excrement
  • After corticosteroid treatment, FVC (a lung volume measure) at one year was about 4.15L, or 107% of predicted, versus 2.72L (73%) at baseline
  • At one year, DLCO (the lung's gas transfer) was 44% of predicted, versus 27% at baseline
  • At one year, the patient walked 80 meters farther in the 6-minute walk test
  • At one year, ground glass opacities had disappeared on the scan, but emphysematous zones remained
  • The authors' literature search found seven published cases of desquamative interstitial pneumonia secondary to metal exposure
• The authors' conclusion: The authors concluded that the patient had desquamative interstitial pneumonia with granulomas secondary to exposure to metals (aluminium, zirconium compound and steel). They described it as, to their knowledge, the first such case linked to zirconium and the third linked to aluminium.

Topics

Medical terms in this study, explained in our Lexicon: Interstitial, Bronchoalveolar Lavage (BAL), Biopsy, Pneumonitis, Occupational Disease.

Related studies

• 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)
• Dyskeratosis congenita showing usual interstitial pneumonia — S. Imokawa, A. Sato, et al. (1994)
• Life after acute fibrinous and organizing pneumonia: a case report of a patient 30 months after diagnosis and review of the literature — C. Kuza, T. Matheos, et al. (2016)
• Electron microscopic studies in desquamative interstitial pneumonia associated with asbestos — B. Corrin, A.B. Price (1972)
• Desquamative interstitial pneumonia associated with chrysotile asbestos fibres — J.A. Freed, A. Miller, et al. (1991)
• Asbestosis and environmental causes of usual interstitial pneumonia — M. Gulati, C.A. Redlich (2015)

Browse return to medical research.