Interstitial pulmonary fibrosis in an automobile body shop worker

Our plain-English summary of Interstitial pulmonary fibrosis in an automobile body shop worker, by A. Fischbein, A.N. Rohl, Y. Suzuki, et al (Toxicology Letters, 1985).

The study

• Authors: A. Fischbein, A.N. Rohl, Y. Suzuki, O. Bigman
• Journal: Toxicology Letters
• Published: 1985;27(1-3):51-7
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Interstitial pulmonary fibrosis (IPF) is often of uncertain etiology and is therefore named 'idiopathic' pulmonary fibrosis. Some occupational exposures, however, are known to cause interstitial fibrosis, asbestos and silica being well-known examples. We present clinical and pathological findings of a case with IPF and the results of microchemical analysis of inorganic particulate matter in the lung tissue. A very high lung burden of inorganic contaminants was found, including silica and metallic compounds. Emphasis is given to the importance of obtaining detailed occupational histories and conducting microchemical analysis of lung tissue in order to clarify etiological factors in cases with 'idiopathic' pulmonary fibrosis.

In plain English

This article was a case report of one man, born in 1911, who worked in an auto body shop from 1941 to 1978 and developed severe interstitial pulmonary fibrosis, a scarring of the lung tissue. At work he used plastic fillers, flexible plastic menders, lead and tin solder, and acrylic lacquer and enamel compounds. He had never done brake maintenance, insulation, shipyard or construction work. A biopsy of his right lung showed severe fibrosis, with features suggestive of desquamative interstitial pneumonitis. He also had liver cirrhosis, and he died after bleeding from esophageal varices. Electron microscopy of his lung tissue showed an extremely large burden of fine inorganic dust, but no asbestos fibers were observed. The dust contained titanium, chromium, aluminum, silicon, iron and potassium. The aluminum and silica were consistent with kaolin clay, and talc may also have been present. Two of his work materials were analyzed. Both contained talc, and one plastic filler also contained asbestiform tremolite. The authors concluded that the match between the lung dust and the work materials was plausible evidence that the disease had an occupational origin.

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), with electron microscopy and microchemical analysis of lung tissue and of work materials
• Who was studied: One male patient born in 1911, a worker in an auto body shop, with severe interstitial pulmonary fibrosis; respiratory symptoms began in 1973; treated at Sinai Hospital of Detroit (authors' affiliations: Mount Sinai, New York, and Sinai Hospital of Detroit)
• Exposure: Work in an auto body shop from 1941 to 1978 with plastic fillers, flexible plastic menders, lead and tin solder mixtures, and acrylic lacquer and enamel compounds, many containing solvents and heavy metals. No brake maintenance, shipyard, construction or insulation work, and no Navy or Merchant Marine service. He never smoked cigarettes but smoked a few cigars per day, and later stopped.
• Main results:
  • A biopsy of the patient's right lung showed severe subpleural and interstitial fibrosis, with most alveolar spaces obliterated and features suggestive of desquamative interstitial pneumonitis (DIP)
  • Transmission electron microscopy of the patient's lung tissue showed an extremely large burden of inorganic particles, which appeared to be aggregates of extremely fine-grained dust
  • No asbestos fibers were observed in the patient's lung tissue
  • The lung dust consisted chemically of titanium, chromium, aluminum, silicon, iron and potassium, with lesser amounts of vanadium, manganese, sulfur, calcium and magnesium. The aluminum and silica together were consistent with kaolin, and talc may also have been present.
  • One plastic filler sample used by the patient was principally talc, and asbestiform tremolite was also found in it (this was in the filler material, not in the lung tissue)
  • A second material used by the patient consisted of talc and kaolin
  • The lung tissue findings corresponded closely with the two work materials, particularly for aluminium silicate (kaolin), titanium, chromium, manganese and iron
  • The patient also had liver cirrhosis and esophageal varices. After bleeding from the varices, he died of cardiac arrest shortly after reaching the emergency room.
• The authors' conclusion: The authors concluded that the match between the lung tissue findings and the materials the patient used in the auto body shop for over three decades was plausible evidence that the lung disease was occupational in origin. They suggested that the compounds found could have been relevant to the fibrosis. They recommended detailed occupational histories and electron microscopy with microchemical tissue analysis in cases of 'idiopathic' pulmonary fibrosis.

Topics

Medical terms in this study, explained in our Lexicon: Interstitial, Pulmonary Fibrosis, Etiology, Idiopathic, Occupational Exposure, Interstitial Fibrosis.

Related studies

• Pulmonary fibrosis, carcinoma, and ferruginous body counts in amosite asbestos workers. A study of six cases — V.L. Roggli, S.D. Greenberg, et al. (1980)
• Asbestosis: interstitial pulmonary fibrosis and pleural fibrosis in a cohort of asbestos insulation workers: influence of cigarette smoking — R. Lilis, I.J. Selikoff, et al. (1986)
• Inhibition of lung injury, inflammation, and interstitial pulmonary fibrosis by polyethylene glycol-conjugated catalase in a rapid inhalation model of asbestosis — B.T. Mossman, J.P. Marsh, et al. (1990)
• Interstitial pulmonary fibrosis environmental or idiopathic? — G.L. Snider (1985)
• Mica-associated pulmonary interstitial fibrosis — S.K. Landas, D.A. Schwartz (1991)
• Agreement between chest radiography and high-resolution computed tomography in diagnosing dust-related interstitial lung fibrosis — R.R. Tiwari (2015)

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