A case of airway aluminosis with likely secondary pleuroparenchymal fibroelastosis

  • Yuki Yabuuchi | jabberflag@hotmail.co.jp Department of Respiratory Medicine, National Hospital Organization, Ibaraki Higashi National Hospital, Ibaraki, Japan.
  • Hitomi Goto Department of Respiratory Medicine, National Hospital Organization, Ibaraki Higashi National Hospital, Ibaraki, Japan.
  • Mizu Nonaka Department of Respiratory Medicine, National Hospital Organization, Ibaraki Higashi National Hospital, Ibaraki, Japan.
  • Hiroaki Tachi Department of Respiratory Medicine, National Hospital Organization, Ibaraki Higashi National Hospital, Ibaraki, Japan.
  • Tatsuya Akiyama Department of Respiratory Medicine, National Hospital Organization, Ibaraki Higashi National Hospital, Ibaraki, Japan.
  • Naoki Arai Department of Respiratory Medicine, National Hospital Organization, Ibaraki Higashi National Hospital, Ibaraki, Japan.
  • Hiroaki Ishikawa Department of Respiratory Medicine, National Hospital Organization, Ibaraki Higashi National Hospital, Ibaraki, Japan.
  • Kentaro Hyodo Department of Respiratory Medicine, National Hospital Organization, Ibaraki Higashi National Hospital, Ibaraki, Japan.
  • Kenji Nemoto Department of Respiratory Medicine, National Hospital Organization, Ibaraki Higashi National Hospital, Ibaraki, Japan.
  • Yukiko Miura Department of Respiratory Medicine, National Hospital Organization, Ibaraki Higashi National Hospital, Ibaraki, Japan.
  • Isano Hase Department of Respiratory Medicine, National Hospital Organization, Ibaraki Higashi National Hospital, Ibaraki, Japan.
  • Shuji Oh-ishi Department of Respiratory Medicine, National Hospital Organization, Ibaraki Higashi National Hospital, Ibaraki, Japan.
  • Kenji Hayashihara Department of Respiratory Medicine, National Hospital Organization, Ibaraki Higashi National Hospital, Ibaraki, Japan.
  • Takefumi Saito Department of Respiratory Medicine, National Hospital Organization, Ibaraki Higashi National Hospital, Ibaraki, Japan.
  • Tatsuya Chonan Department of Medicine, Nikko Memorial Hospital, Ibaraki, Japan.

Abstract

Background: Excessive inhalation of aluminium powder occasionally results in upper lobe predominant lung fibrosis, which is similar to idiopathic pleuroparenchymal fibroelastosis (IPPFE) and has been suggested to be secondary PPFE. Case presentation: A 67-year-old man who had worked in an aluminum-processing factory for 50 years visited our hospital complaining of exertional dyspnea. Chest computed tomography (CT) showed bilateral dense sub-pleural consolidation in the upper and middle lung fields, which was consistent with IPPFE; however, the possibility of secondary PPFE associated with aluminosis was not ruled out. Considering the patient’s critical condition, trans-bronchial lung biopsy (TBLB) rather than surgical lung biopsy was performed, with elemental analysis of the biopsied specimen. Unfortunately, the specimen obtained by TBLB did not contain alveolar tissue; therefore, pathological diagnosis of PPFE was not possible. However, radiographic findings were highly suggestive of PPFE. On elemental analysis, excessive amounts of aluminum were detected in the bronchiolar walls, establishing a diagnosis of airway aluminosis with likely secondary PPFE resulting from aluminium exposure. Conclusions: TBLB with elemental analysis might be useful in differentiating idiopathic PPFE from secondary causes in dust inhalation related disease, such as aluminosis. This case indicated that inhalation of aluminium might cause secondary PPFE, with attention needing to be paid to avoid further exposure.

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Published
2019-04-15
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Section
Case Reports
Keywords:
Interstitial pneumonia, Occupational lung disease, Trans-bronchial lung biopsy, Elemental analysis
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How to Cite
Yabuuchi, Y., Goto, H., Nonaka, M., Tachi, H., Akiyama, T., Arai, N., Ishikawa, H., Hyodo, K., Nemoto, K., Miura, Y., Hase, I., Oh-ishi, S., Hayashihara, K., Saito, T., & Chonan, T. (2019). A case of airway aluminosis with likely secondary pleuroparenchymal fibroelastosis. Multidisciplinary Respiratory Medicine, 14(1). https://doi.org/10.4081/mrm.2019.15