A reconsideration of acute Beryllium disease.
BACKGROUND
Although chronic beryllium disease (CBD) is clearly an immune-mediated granulomatous reaction to beryllium, acute beryllium disease (ABD) is commonly considered an irritative chemical phenomenon related to high exposures. Given reported new cases of ABD and projected increased demand for beryllium, we aimed to reevaluate the patho physiologic associations between ABD and CBD using two cases identified from a survey of beryllium production facility workers.


METHODS
Within weeks after exposure to beryllium fluoride began, two workers had systemic illness characterized by dermal and respiratory symptoms and precipitous declines in pulmonary function. Symptoms and pulmonary function abnormalities improved with cessation of exposure and, in one worker, recurred with repeat exposure. Bronchoalveolar lavage fluid analyses and blood beryllium lymphocyte proliferation tests revealed lymphocytic alveolitis and cellular immune recognition of beryllium. None of the measured air samples exceeded 100 microg/m(3), and most were < 10 microg/m(3), lower than usually described. In both cases, lung biopsy about 18 months after acute illness revealed noncaseating granulomas. Years after first exposure, the workers left employment because of CBD.


CONCLUSIONS
Contrary to common understanding, these cases suggest that ABD and CBD represent a continuum of disease, and both involve hypersensitivity reactions to beryllium. Differences in disease presentation and progression are likely influenced by the solubility of the beryllium compound involved.


CONCLUSIONS
ABD may occur after exposures lower than the high concentrations commonly described. Prudence dictates limitation of further beryllium exposure in both ABD and CBD.
Cummings
Kristin J
KJ
Division of Respiratory Disease Studies, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia 26505, USA. cvx5@cdc.gov
Stefaniak
Aleksandr B
AB
Virji
M Abbas
MA
Kreiss
Kathleen
K
D000328:Adult; D000395:Air Pollutants, Occupational / Q000276:immunology; D001607:Berylliosis / Q000209:etiology / Q000276:immunology* / Q000473:pathology*; D001608:Beryllium / Q000276:immunology / Q000633:toxicity*; D006801:Humans; D006967:Hypersensitivity / Q000276:immunology; D008297:Male; D011848:Radioactive Pollutants / Q000633:toxicity*; D012137:Respiratory System / Q000187:drug effects* / Q000473:pathology*; D012867:Skin / Q000187:drug effects; D055815:Young Adult
D000395:Air Pollutants, Occupational; D011848:Radioactive Pollutants; D001608:Beryllium