Barbee J Y, Prince T S
Department of Preventive Medicine and Environmental Health, University of Kentucky School of Medicine, Lexington, USA.
South Med J. 1999 May;92(5):510-2. doi: 10.1097/00007611-199905000-00012.
A 43-year-old man began having malaise, chills, and fever 12 hours after cutting a galvanized steel grating with an acetylene torch at work. Over the next 72 hours, his symptoms persisted and became worse with progressive shortness of breath. He was admitted to the hospital and begun on antibiotics and steroids. The next day his condition had deteriorated to the point that he had to be intubated. Chest x-ray film and computed tomography showed patchy and interstitial infiltration bilaterally, consistent with acute respiratory distress syndrome. Open lung biopsy showed focal mild interstitial pneumonia. Multiple laboratory studies were negative for an infectious or an immune process. The patient remained on mechanical ventilation for 10 days and was discharged from the hospital 2 days after extubation. He continued to improve, with minimal symptoms and a return to normal activity levels several months after the incident with no continued treatment. Re-creation of his exposure was done under controlled circumstances, with air sampling revealing elevated air levels for cadmium and zinc and borderline levels of arsenic, manganese, lead, and iron.
一名43岁男性在工作中用乙炔炬切割镀锌钢格栅12小时后开始出现不适、寒战和发热。在接下来的72小时里，他的症状持续存在，并随着进行性呼吸急促而加重。他被收治入院，开始使用抗生素和类固醇治疗。第二天，他的病情恶化到必须进行插管的程度。胸部X光片和计算机断层扫描显示双侧有斑片状和间质性浸润，符合急性呼吸窘迫综合征。开放性肺活检显示局灶性轻度间质性肺炎。多项实验室检查对感染或免疫过程均呈阴性。患者接受了10天的机械通气治疗，拔管后2天出院。他持续好转，症状轻微，事件发生几个月后恢复到正常活动水平，无需继续治疗。在可控环境下重现了他的暴露情况，空气采样显示空气中镉和锌的水平升高，砷、锰、铅和铁的水平处于临界值。
