Clinical Briefing: Detection and Management
of Beryllium-Induced Disease
January/February 2008
Today, the Penn Lung
Center is one of six institutions nationwide and the
only center in the Mid-Atlantic and Northeast Region offering
diagnosis and treatment for
beryllium-induced
disease. An occupational granulomatous lung disorder
caused by inhalation of beryllium dust or fumes, beryllium-induced
disease has both acute and chronic pathologies. The acute
form is now extremely rare.
Chronic beryllium disease (CBD),
by contrast, may affect as many as 16,000 individuals in
the United States. Insidious and slow to progress, CBD is
virtually identical pathophysiologically to chronic pulmonary sarcoidosis.
Differentiating
chronic pulmonary sarcoidosis from chronic beryllium disease
is one of the specialties of the Penn Lung Center. For patients
with chronic beryllium disease, early detection, treatment
and removal from further exposure are paramount concerns.
“A suspicion of beryllium exposure must be considered in all patients
with histological evidence of pulmonary granulomata given the 50 year history of beryllium
manufacturing in the US and the increasing use of the metal in a variety of industries
worldwide.”
– Milton Rossman, MD
Director, Interstitial Lung Disease Program
The Penn Lung Center
|
|
Case Study
Mr. W, a 56-year-old man, worked for five years in the early-1980s as a machinist
in a factory manufacturing beryllium copper alloy pipe. His health was good until
late 2001, when he began to experience occasional dyspnea and cough. An X-ray at
this time was negative for lesions or opacifications. When a high-resolution CT in
2005 revealed confluent apical infiltrates in both lungs and evidence of mid-zone
granularity, Mr. W's pulmonologist diagnosed pulmonary sarcoidosis and referred him
to the Penn Lung Center for treatment.
|
High-resolution CT lung scan displaying scarring typical of
beryllium-induced disease. |
|
At Penn, pulmonary function tests confirmed marked reduction of total
lung capacity, vital capacity and diffusion capacity. A cardiopulmonary
exercise test revealed exercise induced oxygen desaturation. Suspecting
CBD from Mr. W's work history, Penn pulmonologists performed a fiberoptic
bronchoscopy and transbronchial biopsy, revealing non-caseating granuloma.
Beryllium
lymphocyte proliferation testing (BeLPT) was performed
on blood and bronchoalveolar lavage cells . These tests proved sensitization
to beryllium and Mr. W was diagnosed with chronic beryllium disease. He
began prednisone, 40 mg, on alternate days, with almost immediate improvement
of his dyspnea. The prednisone was titrated over 6 months to a maintenance
dose.
Our Team of Faculty
The Penn Lung Center enjoys an international reputation as a referral center for the evaluation, diagnosis
and treatment of patients with chronic beryllium disease. In addition to treatment and diagnosis, the
Center’s faculty is available to assist industry in the development of cost-effective screening
programs for beryllium disease, as well as programs for the evaluation and treatment of symptomatic
workers.
Medical Pathology
Leslie A. Litzky, MD
Associate Professor of Pathology and Laboratory Medicine
Pulmonary Medicine
Maryl Kreider, MD, MSCE
Assistant Professor of Medicine
Milton Rossman, MD
Professor of Medicine
Radiology
Wallace T. Miller, Jr., MD
Associate Professor of Radiology
|
|
Referring Physicians: To speak with a Penn physician
or refer a patient, contact PennHealth through the secure online
referral form or by calling
1-800-789-PENN
(7366). |
 |
|
|
|
