Alveolar proteinosis associated with aluminium dust inhalation.
Secondary alveolar proteinosis is a rare lung disease which may be triggered by a variety of inhaled particles. The diagnosis is made by detection of anti-granulocyte-macrophage colony-stimulating factor antibodies in bronchoalveolar lavage fluid, which appears milky white and contains lamellar bodies. Aluminium has been suggested as a possible cause, but there is little evidence in the literature to support this assertion. We report the case of a 46-year-old former boilermaker and boat builder who developed secondary alveolar proteinosis following sustained heavy aluminium exposure. The presence of aluminium was confirmed both by histological examination and metallurgical analysis of a mediastinal lymph node. Despite cessation of exposure to aluminium and treatment with whole-lung lavage which normally results in improvements in both symptoms and lung function, the outcome was poor and novel therapies are now being used for this patient. It may be that the natural history in aluminium-related alveolar proteinosis is different, with the metal playing a mediating role in the disease process. Our case further supports the link between aluminium and secondary alveolar proteinosis and highlights the need for measures to prevent excessive aluminium inhalation in relevant industries.
Department of Respiratory Medicine, Gold Coast University Hospital, Southport, Queensland 4215, Australia, School of Medicine, Griffith University, Southport, Queensland 4222, Australia.
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Chew
School of Medicine, Griffith University, Southport, Queensland 4222, Australia, Department of Anatomical Pathology, Gold Coast University Hospital, Southport, Queensland 4215, Australia.
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Nigam
Department of Respiratory Medicine, Gold Coast University Hospital, Southport, Queensland 4215, Australia, School of Medicine, Griffith University, Southport, Queensland 4222, Australia, siva.sivakumaran@health.qld.gov.au.
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Sivakumaran
D000280:Administration, Inhalation; D000535:Aluminum / Q000008:administration & dosage / Q000009:adverse effects* / Q000378:metabolism; D001992:Bronchoalveolar Lavage Fluid; D060389:Construction Industry; D004391:Dust; D006801:Humans; D008168:Lung / Q000187:drug effects* / Q000378:metabolism / Q000473:pathology; D008198:Lymph Nodes / Q000378:metabolism; D008297:Male; D066192:Manufacturing Industry; D008482:Mediastinum; D008875:Middle Aged; D009784:Occupational Diseases / Q000175:diagnosis / Q000209:etiology* / Q000378:metabolism / Q000473:pathology; D016273:Occupational Exposure / Q000009:adverse effects*; D009790:Occupations; D011649:Pulmonary Alveolar Proteinosis / Q000175:diagnosis / Q000209:etiology* / Q000378:metabolism / Q000473:pathology; D012767:Ships
D004391:Dust; D000535:Aluminum
Exposure assessment; metals; pulmonary; pulmonary function.