Extrinsic Allergic
Chest clinic Thorax: first published as 10.1136/thoraxjnl-2014-205251 on 8 July 2014. Downloaded from CASE BASED DISCUSSION Lesson of the month: extrinsic allergic (bronchiolo) alveolitis and metal working fluids Paul Cullinan,1 Eva D’Souza,2 Rachel Tennant,3 Chris Barber4 1Department of Occupational INTRODUCTION since he had never kept them, a probable attribu- and Environmental Medicine, One of us was asked to consider a diagnosis of tion to ‘birds’ had been made. He had been Imperial College (NHLI) and Royal Brompton Hospital, occupational asthma for a man who had worked treated, intermittently, with high doses of prednis- London, UK for 20 years as a metal turner in a large, modern olone with no evidence of lasting benefit. The 2Health Management Limited, factory producing specialised machine parts. He survey of other employees and subsequent specialist London, UK 3 described a 2 year history of severe breathlessness investigation established a further two cases of Department of Respiratory that improved when he was not at work. His spir- occupational bronchioloalveolitis with probable Medicine, Northwick Park – Hospital, London, UK ometry was restrictive with a FEV1 of 1.35 L (40% onset in 2010 2011. 4Centre for Workplace Health, predicted) and FVC of 1.8 L (45% predicted), a Northern General Hospital, ratio of 75%. Other lung function measurements DISCUSSION Brearley Outpatient, Herries indicated gas trapping; his TLC was 5.01 L (79% These five men had a diagnosis and an occupation in Road, Sheffield, UK predicted) and RV/TLC 170% predicted. A high common; all were metal machinists in a single Correspondence to resolution CT scan of his lungs revealed a wide- factory, a job that entails exposure to mists of metal Dr Paul Cullinan, Department spread ‘mosaic’ pattern of attenuation indicative of working fluids (MWFs).
[Show full text]