Environmental Medicine Integrating a Missing Element into Medical Education (1995) / Chapter Skim
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Case Study 5: Beryllium Toxicity
Case Study 5: Beryllium Toxicity
Pages 208-223
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From page 208... ...
Chronic beryllium disease may be misdiagnosed as sarcoidosis. New immunologic tests promise early detection of beryllium disease and differenhafion from other interstitial lung diseases.
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From page 209... ...
Chest X ray shows minimal peribronchial th~ken;ng and is otherwise normal. Pretests .
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From page 210... ...
Pure beryllium metal is used in aircraft disc brakes, X-ray components, space-vehicle optics and instruments, aircrafVsatellite structures, missile parts, nuclear-reactor neutron reflectors, nuclear weapons, fuel containers, precision instruments, rocket propellants, navigational systems, heat shields, and mirrors. Beryllium alloys also have many uses, including electrical connectors and relays, springs, precision instruments, aircraft engine parts, nonsparking and nonmagnetic tools, computers, ceramics, submarine cable housings and pivots, wheels and pinions, and dental castings.
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From page 211... ...
Acute beryllium disease manifests as pulmonary inflammation, whereas chronic beryllium disease is typically a progressive pulmonary granulomatosis. Low, seemingly trivial exposures to beryllium may be important in causing beryllium disease.
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From page 212... ...
The biopsy result and areviewof the chess radiograph andpatient history lead you to include chronic beryllium disease in the differential diagnosis. (A How might the father have come in contact with beryllium?
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From page 213... ...
In chronic disease, which occurs in susceptible persons, a cell-mediated, delayed hypersensitivity reaction is involved. Inflammatory acute disease can progress to granulomatous chronic beryllium disease.
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From page 214... ...
Skin contact with soluble beryllium compounds can induce beryllium sensitization and cause contact dermatitis. Beryllium-containing particles that lodge in a worker's skin can cause skin ulceration; biopsy reveals noncaseating granulomas at the site of injury.
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From page 215... ...
O Acute beryllium toxicity causes a nonspecific Inflammatory reaction in the respiratory tract. O Exertional dyspnea is the most common symptom of chronic beryllium disease 7 215 ENVIRONMENTAL MEDICINE
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From page 216... ...
Differential Diagnosis The differential diagnosis for interstitial and granulomatous lung disease is long. Conditions that may resemble chronic beryllium disease include tuberculosis, fungal disease, asbestosis, silicosis, hypersensitivity pneumonitis, puirnonary hemosiderosis, Iymphanglic spread of carcinoma, and sarcoidosis.
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From page 217... ...
Pulmonary evaluation for chronic beryllium disease, as for all interstitial lung diseases, includes chest X ray, pulmonary function tests, arterial blood gas measurements, and possibly bronchoscopy with tissue biopsy and ravage analysis for cell count, differential, and Iymphocyte count. Chest radiograph findings may include diffuse infiltrates and hulas adenopathy, but can be negative.
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From page 218... ...
Although there is little scientific evidence that cessation of exposure alters the course of beryllium disease once it is manifest, exposure cessation should be the first goal of management. For patients with chronic beryllium disease, corticosteroid therapy is the primary treatment modality.
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From page 219... ...
EPA considers beryllium a probable human carcinogen. Workplace Air The Occupational Safety and Health Administration (OSHA)
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From page 220... ...
Focus Level Comments ACGIH Air-workplace 2 ~/m3 Advisory; TLV-TWAt NIOSH Air-workplace 0.5~tm3 Advisory; 10-hrTWA OSHA Air-workplace 2 Imp Regulation; PEL§asTWA 5 Imp Regulation; Ceiling 25 ~/m3 Regulation; STEM 30-mint maximum peak EPA Drinking water 68 ng/L for consumption of 2L Advisory Air 10 9 24-hr period Regulation ' ACGIH _ American Conference of Governmental Industrial Hygienists; EPA = Environmental Protection Agency; NIOSH = National Institute for Occupational Safety and Health; 0SHA = Occupational Safety and Health Administration t TLV-TWA (Threshold Limit Value-Time-Weighted Average) = Time-weighted average concentration for a normal workday and a 40-hour workweek to which nearly all workers may be repeatedly exposed.
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From page 221... ...
Mroz MM, Kreiss K, Lezotte DC, Campbell PA, Newman LS. Reexamination of the blood Iymphoc,vte transformation test in the diagnosis of chronic beryllium disease.
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From page 222... ...
. Chronic cough is a common symptom of chronic beryllium disease, which can be misdiagnosed as sarcoidosis unless specifically tested for.
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From page 223... ...
An abnormal blood beryllium-stimulated lymphocyte transformation test would indicate an increased probability that both the cutaneous and pulmonary abnormalities are due to beryllium exposure. A negative blood test, however, would not exclude the diagnosis of chronic beryllium disease.
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