Pneumoconioses

Case history #1

A 76-year-old retired foundry worker has shortness of breath with activity that has been gradually getting worse, and a chronic cough. He denies chest pain. He has a 45-pack/year smoking history, but quit at age 50. There is no family history of lung disease. He does not take any respiratory medication on a regular basis. He has noticed he wheezes when he has an upper respiratory infection, and his doctor once prescribed him an inhaler. He is also bothered by joint swelling and stiffness. Lung auscultation is normal. (This case is a common clinical presentation of silicosis or coal workers' pneumoconiosis.)

Case history #2

A 35-year-old man who works machining beryllium-copper alloy for the electronics industry is concerned about the possibility of adverse health effects from beryllium, which is a component of the metal he is machining. He has heard about a blood test that can be used for diagnosing beryllium disease. He is not sure if he has had some increased shortness of breath with exercise. He has never smoked cigarettes. He has no personal or family history of allergies or asthma. Lung auscultation is normal. (This case is a common clinical presentation of chronic beryllium disease.)

Other presentations

A relatively acute onset of marked shortness of breath is typical of acute silicosis with alveolar proteinosis, as well as acute berylliosis, which presents as an acute pneumonitis. Acute silicosis or beryllium pneumonitis, due to particularly heavy exposure to silica or beryllium, rarely occur in developed countries.

Patients with silicosis are at increased risk of active pulmonary tuberculosis if they are exposed to Mycobacterium tuberculosis, and may present with hemoptysis, night sweats, and fever.

Presentation may also be with predominantly nonrespiratory symptoms, such as symptoms of scleroderma or rheumatoid arthritis, which are less-common complications of silica or coal exposure.