Tan K L, Lee H S, Poh W T, Ren M Q, Watt F, Tang S M, Eng P
Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore.
Ann Acad Med Singap. 2000 Jul;29(4):521-7.
We report the first case of hard metal lung disease in Singapore and the occupational investigative work and control measures that were undertaken.
A 38-year-old machinist in the tool manufacturing industry presented with exertional dyspnoea and cough. Chest X-ray revealed bilateral reticulonodular infiltrates with honeycombing. High resolution computed tomography scan of the thorax confirmed the presence of interstitial fibrosis. Open biopsy of the lung showed features of pneumoconiosis. Particle induced X-ray emission (PIXE) analysis, a relatively new elemental analysis technique, performed on the lung biopsy specimen confirmed the presence of tungsten and titanium; and he was diagnosed to have hard metal lung disease. Microbiologic, serologic and histologic investigations excluded an infective cause. Serial pulmonary function tests on follow-up showed no progression. He presented with haemoptysis 10 months later and was diagnosed to have tuberculosis on the basis of positive sputum and bronchoalveolar lavage cultures for Mycobacterium tuberculosis complex.
Preventive measures and permanent transfer to non-cobalt work were instituted.
The interstitial fibrosis appears to have stabilised.
The diagnosis of hard metal lung disease must be considered in a worker exposed to cobalt presenting with interstitial fibrosis.
我们报告新加坡首例硬质合金肺病病例以及所开展的职业调查工作和控制措施。
一名38岁从事工具制造业的机械师出现劳力性呼吸困难和咳嗽。胸部X光显示双侧网状结节浸润伴蜂窝状改变。胸部高分辨率计算机断层扫描证实存在间质性纤维化。肺部开放活检显示尘肺特征。对肺活检标本进行的粒子激发X射线发射（PIXE）分析（一种相对较新的元素分析技术）证实存在钨和钛；他被诊断为患有硬质合金肺病。微生物学、血清学和组织学检查排除了感染性病因。随访期间的系列肺功能测试显示病情无进展。10个月后他出现咯血，基于痰和支气管肺泡灌洗培养出结核分枝杆菌复合群阳性而被诊断为肺结核。
采取了预防措施并将其永久调至不接触钴的工作岗位。
间质性纤维化似乎已稳定。
对于接触钴且出现间质性纤维化的工人，必须考虑硬质合金肺病的诊断。
