title: A case of mixed dust pneumoconiosis with desquamative interstitial pneumonia-like reaction in an aluminum welder.
abstract: A 60-year-old man presented with an 18-month history of gradually worsening cough and a 12-month history of dyspnea on exertion. High-resolution computed tomography showed bilateral uniform ground grass opacity in the lower lung fields, partially resolved by smoking cessation. A tentative diagnosis of desquamative interstitial pneumonia (DIP) was made. Video-assisted thoracic surgery was performed and pathological analysis showed peribronchiolar fibrosis with intra-alveolar macrophage infiltration. Elemental analysis detected aluminum and iron in the upper lobe and only iron in the lower lobe. Thus, a definitive diagnosis of mixed dust pneumoconiosis with DIP-like reaction was made. DIP-like reaction is known to be a reactive change caused by exposure to tobacco smoke as well as by inhalation of inorganic particles. Obtaining a detailed medical history including occupational and environmental risk factors is important to distinguish cases of DIP-like reaction due to exposure to inorganic particles from the usual cases related to smoking, and thus provide suitable treatment.
authors.affiliation: Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University, 3311-1, Yakushiji, Shimotsuke, Tochigi, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Iijima
authors.affiliation: Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University, 3311-1, Yakushiji, Shimotsuke, Tochigi, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Bando
authors.affiliation: Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University, 3311-1, Yakushiji, Shimotsuke, Tochigi, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Yamasawa
authors.affiliation: Division of Respiratory Medicine, Department of Homeostatic Regulation and Development, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Moriyama
authors.affiliation: Department of Pathology, Japanese Red Cross Medical Center, Tokyo, Japan.
authors.forename: Tamiko
authors.initials: T
authors.lastname: Takemura
authors.affiliation: Department of Pathology, Jichi Medical University School of Medicine, Tochigi, Japan.
authors.forename: Toshiro
authors.initials: T
authors.lastname: Niki
authors.affiliation: Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University, 3311-1, Yakushiji, Shimotsuke, Tochigi, Japan.
authors.forename: Yukihiko
authors.initials: Y
authors.lastname: Sugiyama
keywords: Aluminum lung; Desquamative interstitial pneumonia; Metal analysis; Pneumoconiosis