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Kurosaki F, Takemura T, Bando M, Kuroki T, Numao T, Moriyama H, Hagiwara K. Progressive plasterer's pneumoconiosis complicated by fibrotic interstitial pneumonia: a case report. BMC Pulm Med 2019; 19:6. [PMID: 30616611 PMCID: PMC6323823 DOI: 10.1186/s12890-018-0776-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 12/28/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although the prevalence of pneumoconiosis has been decreasing due to improvements in working conditions and regular health examinations, occupational hygiene measures are still being established. Plasterers encounter a number of hazardous materials that may be inhaled in the absence of sufficient protection. CASE PRESENTATION A 64-year-old man who plastered without any dust protection for more than 40 years was referred to our hospital with suspected interstitial pneumonia. Mixed dust pneumoconiosis and an unusual interstitial pneumonia (UIP) pattern with fibroblastic foci were diagnosed by video-assisted thoracoscopic surgery, and an elemental analysis detected elements included in plaster work materials. Despite the cessation of plaster work and administration of nintedanib, the patient developed advanced respiratory failure. CONCLUSION Plasterers are at an increased risk of pneumoconiosis and may have a poor prognosis when complicated by the UIP pattern. Thorough dust protection and careful monitoring are needed.
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Affiliation(s)
- Fumio Kurosaki
- Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan. .,Department of Pulmonary Medicine, National Hospital Organization Utsunomiya National Hospital, 2160 Shimo-Okamoto, Utsunomiya, Tochigi, 329-1193, Japan.
| | - Tamiko Takemura
- Department of Pathology, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan
| | - Masashi Bando
- Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Tomonori Kuroki
- Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.,Department of Pulmonary Medicine, National Hospital Organization Utsunomiya National Hospital, 2160 Shimo-Okamoto, Utsunomiya, Tochigi, 329-1193, Japan
| | - Toshio Numao
- Department of Pulmonary Medicine, National Hospital Organization Utsunomiya National Hospital, 2160 Shimo-Okamoto, Utsunomiya, Tochigi, 329-1193, Japan
| | - Hiroshi Moriyama
- Division of Respiratory Medicine, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi-dori, Niigata, 951-8510, Japan
| | - Koichi Hagiwara
- Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
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Yi MK, Choi WJ, Han SW, Song SH, Lee DH, Kyung SY, Han SH. Overlap syndrome with Sjögren's syndrome and systemic sclerosis in a steel rolling mill worker: a case report. Ann Occup Environ Med 2016; 28:24. [PMID: 27257502 PMCID: PMC4890486 DOI: 10.1186/s40557-016-0106-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 04/26/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are few reports about work-related factors associated with Sjögren's syndrome. We report a case of overlap syndrome with Sjögren's syndrome and systemic sclerosis. CASE PRESENTATION A 54-year-old man was admitted due to dyspnea on exertion. The results of physical examination and laboratory findings were compatible with Sjögren's syndrome with systemic sclerosis. The patient had no pre-existing autoimmune disease, and denied family history of autoimmune disease. The patient worked in the large-scale rolling department of a steel manufacturing company for 25 years. Hot rolling is a rolling process performed at between 1100 °C and 1200 °C, generating a high temperature and a large amount of fumes, involving jet-spraying of water throughout the process to remove the instantaneously generated oxide film and prevent the high generation of fumes. In this process, workers could be exposed to silica produced by thermal oxidation. Other potential toxic substances including nickel and manganese seemed to be less likely associated with the patient's clinical manifestations. CONCLUSIONS Occupational exposure to silica seemed to be associated with the patient's clinical manifestations of overlap syndrome with Sjögren's syndrome and systemic sclerosis. Although the underlying mechanism is still unclear, autoimmune disease including Sjögren's syndrome affects women more often than men and there was no family history of autoimmune disease. These suggested that there was an association between occupational silica exposure and the disease of the patient. Future research about the association between long-term low dose exposure to silica and the development of autoimmune diseases should be encouraged.
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Affiliation(s)
- Min-Kee Yi
- Department of Occupational & Environmental Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Won-Jun Choi
- Department of Occupational & Environmental Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Sung-Woo Han
- Department of Occupational & Environmental Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Seng-Ho Song
- Department of Occupational & Environmental Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Dong-Hoon Lee
- Department of Occupational & Environmental Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Sun Young Kyung
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Sang-Hwan Han
- Department of Occupational & Environmental Medicine, Gachon University Gil Medical Center, Incheon, Korea
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Stejskal V, Reynolds T, Bjørklund G. Increased frequency of delayed type hypersensitivity to metals in patients with connective tissue disease. J Trace Elem Med Biol 2015; 31:230-6. [PMID: 25636536 DOI: 10.1016/j.jtemb.2015.01.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 01/05/2015] [Accepted: 01/06/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND Connective tissue disease (CTD) is a group of inflammatory disorders of unknown aetiology. Patients with CTD often report hypersensitivity to nickel. We examined the frequency of delayed type hypersensitivity (DTH) (Type IV allergy) to metals in patients with CTD. METHODS Thirty-eight patients; 9 with systemic lupus erythematosus (SLE), 16 with rheumatoid arthritis (RA), and 13 with Sjögren's syndrome (SS) and a control group of 43 healthy age- and sex-matched subjects were included in the study. A detailed metal exposure history was collected by questionnaire. Metal hypersensitivity was evaluated using the optimised lymphocyte transformation test LTT-MELISA(®) (Memory Lymphocyte Immuno Stimulation Assay). RESULTS In all subjects, the main source of metal exposure was dental metal restorations. The majority of patients (87%) had a positive lymphocyte reaction to at least one metal and 63% reacted to two or more metals tested. Within the control group, 43% of healthy subjects reacted to one metal and only 18% reacted to two or more metals. The increased metal reactivity in the patient group compared with the control group was statistically significant (P<0.0001). The most frequent allergens were nickel, mercury, gold and palladium. CONCLUSIONS Patients with SLE, RA and SS have an increased frequency of metal DTH. Metals such as nickel, mercury and gold are present in dental restorative materials, and many adults are therefore continually exposed to metal ions through corrosion of dental alloys. Metal-related DTH will cause inflammation. Since inflammation is a key process in CTDs, it is possible that metal-specific T cell reactivity is an etiological factor in their development. The role of metal-specific lymphocytes in autoimmunity remains an exciting challenge for future studies.
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Affiliation(s)
- Vera Stejskal
- Wenner-Gren Institute for Experimental Biology, University of Stockholm, Stockholm, Sweden.
| | - Tim Reynolds
- Chemical Pathology, Burton Hospitals NHS Foundation Trust, Burton upon Trent, United Kingdom
| | - Geir Bjørklund
- Council for Nutritional and Environmental Medicine, Mo i Rana, Norway
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