Monday, July 28, 2008

Occupational History

A 50 year old male who works in the fluorescent lamp industry presents with nonspecific symptoms of dry cough, shortness of breath, night sweats, fatigue, and weight loss. Examination reveals bibasilar rales and clubbing. Labs show hypercalcemia. CXR is normal. PPD is negative. A methacholine stimulation test is negative. Transbronchial biopsy shows noncaseating granulomas and mononuclear cell infiltrates.

Challenge: Given the occupational history, one diagnosis is a little more likely than sarcoidosis (I know you were thinking it). What is it?

3 comments:

Kate said...

berylliosis?

Alex said...

just guessing - lymphoma?

Craig said...

Occupational History

This is chronic beryllium disease or berylliosis. Testing should include a beryllium lymphocyte proliferation test. Exposures occur in those in metal machining, ceramics, technology, and nuclear weapons manufacturing.

Source: UpToDate.