Acute eosinophilic pneumonia in a New York City firefighter exposed to World Trade Center dust.
We report a sentinel case of acute eosinophilic pneumonia in a firefighter exposed to high concentrations of World Trade Center dust during the rescue effort from September 11 to 24. The firefighter presented with a Pa(O2) of 53 mm Hg and responded to oxygen and corticosteroids. Computed tomography scan showed patchy ground glass density, thickened bronchial walls, and bilateral pleural effusions. Bronchoalveolar lavage recovered 70% eosinophils, with only 1% eosinophils in peripheral blood. Eosinophils were not degranulated and increased levels of interleukin-5 were measured in bronchoalveolar lavage and serum. Mineralogic analysis counted 305 commercial asbestos fibers/10(6) macrophages including those with high aspect ratios, and significant quantities of fly ash and degraded fibrous glass. Acute eosinophilic pneumonia is a rare consequence of acute high dust exposure. World Trade Center dust consists of large particle-size silicates, but fly ash and asbestos fibers may be found in bronchoalveolar lavage cells.
Rom
William N
WN
Division of Pulmonary and Critical Care Medicine, Department of Medicine, New York University School of Medicine, New York 10016, USA. william.rom@med.nyu.edu
Weiden
Michael
M
Garcia
Roberto
R
Yie
Ting An
TA
Vathesatogkit
Pratan
P
Tse
Doris B
DB
McGuinness
Georgeann
G
Roggli
Victor
V
Prezant
David
D
D000208:Acute Disease; D000284:Administration, Oral; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use; D017639:Asbestos, Amosite / Q000032:analysis; D001992:Bronchoalveolar Lavage Fluid / Q000166:cytology; D004391:Dust / Q000009:adverse effects*; D004804:Eosinophils / Q000166:cytology; D005390:Fires; D005500:Follow-Up Studies; D005898:Glass / Q000032:analysis; D006801:Humans; D008297:Male; D008854:Microscopy, Electron; D009519:New York City; D009784:Occupational Diseases / Q000209:etiology*; D009790:Occupations; D011241:Prednisone / Q000008:administration & dosage / Q000627:therapeutic use; D011657:Pulmonary Eosinophilia / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D013902:Radiography, Thoracic; D018635:Rescue Work; D015208:Smoke Inhalation Injury / Q000150:complications* / Q000209:etiology; D023481:Terrorism; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D004391:Dust; C009753:fiberglass; D017639:Asbestos, Amosite; D011241:Prednisone