Hard Metal Pneumoconiosis Pneumonitis



Hard Metal Pneumoconiosis Pneumonitis







Key Facts


Terminology



  • Type of pneumonitis caused by exposure to hard metal (cobalt)


Etiology/Pathogenesis



  • Exposure to hard metal


  • Hard metal is combination of tungsten with cobalt


Clinical Issues



  • Symptoms



    • Cough


    • Dyspnea


    • Rhinitis


    • Dermatitis


    • Asthma


  • Laboratory findings



    • Increased cobalt in urine


    • Increased cobalt in blood


  • Treatment



    • Corticosteroids


Top Differential Diagnoses



  • Usual interstitial pneumonitis


  • Desquamative interstitial pneumonitis


  • Infectious pneumonia


  • Langerhans cell histiocytosis


Diagnostic Checklist



  • Presence of giant cells


  • Patchy and subtle nodular appearance


  • Inflammatory reaction


  • Lymphoid aggregates


  • History of exposure to hard metal






Low-power view of hard metal pneumonitis shows a patchy and subtle nodular growth pattern. There are at least 2 nodule-like image areas within the lung parenchyma.






High-power view of hard metal pneumonitis shows a collection of intraalveolar macrophages admixed with multinucleated giant cells image.


TERMINOLOGY


Synonyms



  • Hard metal lung disease, cobalt lung disease


Definitions



  • Type of pneumonitis caused by exposure to hard metal (cobalt and others)


ETIOLOGY/PATHOGENESIS


Environmental Exposure



  • Exposure to hard metal



    • Hard metal is combination of tungsten with cobalt


Pathogenesis



  • Possibly immunologically mediated disease


CLINICAL ISSUES


Epidemiology



  • Incidence



    • No hard data documenting true incidence of hard metal lung disease


  • Age



    • Adults are more commonly affected


  • Gender



    • No apparent gender predilection


  • Ethnicity



    • No apparent ethnic predilection


Site



  • Lung without predilection for any side or segment


Presentation



  • Cough


  • Dyspnea


  • Chest pain


  • Wheezing


  • Rhinitis


  • Conjunctivitis


  • Dermatitis


  • Asthma


  • Malaise


Laboratory Tests



  • Radiographic features are nonspecific


  • Increased cobalt in urine


  • Increased cobalt in blood


  • IgE antibodies to cobalt may be present in serum


Treatment



  • Drugs



    • Corticosteroids


    • In cases not responding to corticosteroids



      • Cyclophosphamide


      • Azathioprine


      • Lung transplantation


    • Most important aspect is to avoid contact with cobalt


Prognosis



  • If patients are kept away form further exposure to cobalt and treated with corticosteroids, their prognosis may be good


  • Fatal cases have been reported

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Jul 9, 2016 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Hard Metal Pneumoconiosis Pneumonitis

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