title: A fatal case of hard-metal disease.
abstract: OBJECTIVE
  The purpose of this report is to present a case of hard-metal disease in which the symptoms and findings were minimal early in the disease, but further exposure rapidly led to a fatal outcome.
  
  
  METHODS
  A 22-year-old nonsmoking white male, employed for over four years in hard-metal tool grinding, started experiencing a dry cough and shortness of breath during exercise. Preliminary investigations did not reveal any cause for these symptoms, and the patient continued to work. Several months later he developed clinically apparent alveolitis with recurrent pneumothorax. Pulmonary infiltrates in chest radiographs did not disappear during corticosteroid treatment. Soon it was evident that the patient had irreversible pulmonary failure, and a bilateral lung transplantation was performed. No signs of rejection were seen in the resected lungs. The patient died of pneumonia five months later, but no signs of hard-metal disease were found in the transplanted lung.
  
  
  CONCLUSIONS
  This fatal case of hard-metal lung disease demonstrates that symptoms and findings in pulmonary function tests or chest radiographs may be minimal or misleading in the early stages of the disease. Cobalt-exposed workers with inexplicable respiratory symptoms should be closely monitored and the exposure should be suspended.
authors.affiliation: Turku University Central Hospital, Department of Pulmonary Diseases, Finland.
authors.forename: E L
authors.initials: EL
authors.lastname: Ruokonen
authors.forename: M
authors.initials: M
authors.lastname: Linnainmaa
authors.forename: M
authors.initials: M
authors.lastname: Seuri
authors.forename: P
authors.initials: P
authors.lastname: Juhakoski
authors.forename: K O
authors.initials: KO
authors.lastname: Söderström
mesh_terms: D000328:Adult; D003035:Cobalt / Q000009:adverse effects*; D017809:Fatal Outcome; D005387:Finland; D006801:Humans; D016040:Lung Transplantation; D008297:Male; D008670:Metals / Q000009:adverse effects; D009784:Occupational Diseases / Q000209:etiology* / Q000473:pathology; D011658:Pulmonary Fibrosis / Q000209:etiology* / Q000473:pathology; D013997:Time Factors
chemical_list: D008670:Metals; D003035:Cobalt