Pulmonary alveolar proteinosis and cement dust: a case report.
Pulmonary alveolar proteinosis developed in a 29-year-old white man within 2 years of working as a cement truck driver. Pulmonary alveolar proteinosis (PAP), an uncommon respiratory disorder characterized by the accumulation of phospholipid material within the alveoli, has been described in association with exposure to silica, aluminum oxide, and a variety of dusts and fumes. Although a link between exposure to Portland cement and PAP has not been previously noted, this type of cement contains nearly 20% silica. Lung biopsy material, originally used to diagnose PAP, was reviewed under electron dispersive spectroscopy. Analysis indicated the presence of silica particles within the alveolar fluid and macrophages. A number of items support a causal relationship between exposure to cement dust and PAP: (1) the temporal sequence between assuming job duties and the development of the illness, (2) improvement following removal from further exposure, (3) dusty, unprotected working conditions, (4) the presence of silica within the cement, and (5) the alveolar fluid from periodic acid-Schiff-positive lung tissue.
McCunney
R J
RJ
Cabot Corporation, Waltham, MA 02254.
Godefroi
R
R
D000328:Adult; D000395:Air Pollutants, Occupational / Q000009:adverse effects*; D000537:Aluminum Oxide / Q000009:adverse effects; D017610:Calcium Compounds; D002133:Calcium Sulfate / Q000009:adverse effects; D003252:Construction Materials / Q000009:adverse effects*; D005290:Ferric Compounds / Q000009:adverse effects; D006801:Humans; D008277:Magnesium Oxide / Q000009:adverse effects; D008297:Male; D009784:Occupational Diseases / Q000209:etiology*; D000073718:Pancreatitis-Associated Proteins; D011649:Pulmonary Alveolar Proteinosis / Q000209:etiology*; D017640:Silicates; D012824:Silicic Acid / Q000009:adverse effects
D000395:Air Pollutants, Occupational; D017610:Calcium Compounds; D005290:Ferric Compounds; D000073718:Pancreatitis-Associated Proteins; C000612141:REG3A protein, human; D017640:Silicates; D012824:Silicic Acid; C000499:ferric oxide; D008277:Magnesium Oxide; D000537:Aluminum Oxide; C031293:calcium silicate; D002133:Calcium Sulfate