Interstitial Lung Diseases	37
of Occupational Origin

Antje Prasse, Caroline Quartucci, Gernot Zissel,

Gian Kayser, Joachim Müller-Quernheim,

and Björn Christian Frye

Case Vignette

Sarcoidosis was diagnosed in an asymptomatic dental technician aged 21 years. Two years later prednisolone treatment was initiated due to nonproductive cough and progressive defects in both vital and diffusion capacity. Relapses during tapering corticosteroids lead to prolonged therapy until 37 years of age. At this age, still typical clinical and radiological ndings of sarcoidosis were present, and exposure to beryllium-­ containing dust in dental laboratories became known. In-vitro lymphocyte proliferation of peripheral mononuclear cells cultured in the presence of beryllium sulfate (beryllium LPT) yielded an elevated stimulation index demonstrating beryllium sensitization. Thus, a detailed occupational history with subsequent proof of beryllium exposure in combination with clinical and radiological ndings typical of sarcoidosis and demonstration of beryllium sensitization lead to the diagnosis of chronic beryllium disease persistent after termination of exposure.

A. Prasse

Department of Pneumology Medical Center, University of Hannover, Hannover, Germany

C. Quartucci

Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany

G. Zissel · J. Müller-Quernheim · B. C. Frye (*) Department of Pneumology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany

e-mail: [e-mail]

G. Kayser

Institute of Pathology Naehrig Mattern Kayser, Freiburg, Germany

Introduction

Interstitial lung diseases (ILD) comprise a wide range of disease that manifest with radiological and /or histological alterations of the pulmonary interstitial tissue. These patterns and the clinical context allow their classi cation [1]. Occupational exposure plays an important role as contributing factor for interstitial lung diseases, even though the majority of interstitial lung diseases is not considered as being of occupational origin. However, detailed analysis of working environment together with a high grade of suspicion can result in linking workplace exposure to interstitial lung disease as described in the case vignette [2] and allow preventive strategies as it is, e.g., recommended for chronic beryllium disease or silicosis [3, 4].

Besides the prototypic occupation-related interstitial lung diseases discussed in detail, it should be noted that epidemiological studies reveal occupational risk factors for developing “idiopathic” interstitial lung diseases. For idiopathic pulmonary brosis epidemiological studies reveal a correlation between occupational exposure especially to metal and wood dusts, but also to vegetable or stone dusts [5–9]. Inre ghters exposed to dust from World Trade Center collapse a higher incidence of sarcoidosis could be observed [10] emphasizing an exposure-related development of sarcoidosis. Additional studies demonstrated that employment in areas like metal working, health care or teaching represents a risk factor for mortality in sarcoidosis [11] and that environmental factors may mimic occupational exposure [12]. In this context a recent case report highlights the need for clinical suspicion to unravel occupational exposure in the setting of interstitial lung diseases. Two patients with granulomatous lung disease shared exposition to dust containing amorphous silica that was found within the granulomatous lesions. Stopping exposure lead to clinical and functional improvement [13].

Occupational exposure may cause different forms of interstitial lung diseases that can roughly be subdivided in subgroups, i.e., pneumoconiosis, hypersensitivity pneumoni-

© Springer Nature Switzerland AG 2023	641
V. Cottin et al. (eds.), Orphan Lung Diseases, https://doi.org/10.1007/978-3-031-12950-6_37

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