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A fatal case of hard metal disease in a 22 year old Finnish male tool grinder with no history of atopy or smoking was presented. After working for over 4 years in hard metal tool grinding, the patient began to experience a dry cough and shortness of breath during physical exercise. Chest radiographs taken during this time appeared normal, but slight opacities were noted when the films were reviewed at a later date. Several months later, the patient's airway resistance and specific airway conductance were 73% and 141% of normal values, respectively. The total lung capacity and lung volumes were very low, but the subject continued to work. Clinically apparent alveolitis with recurrent pneumothorax developed several months afterward, and lung infiltrates were resistant to corticosteroid treatment. Open lung biopsy revealed carbon and birefringent crystals in the macrophages and fibrotic tissue, and tungsten-carbide in dry lung tissue. The patient was diagnosed with irreversible pulmonary failure, and a bilateral lung transplantation was performed. Despite a successful operation without complications, the patient died 5 months later from pneumonia. An autopsy did not show signs of rejection or hard metal disease in the lungs. The authors conclude that the early stages of hard metal disease may show only minimal or misleading symptoms and findings, and recommend close monitoring and cessation of exposure for cobalt exposed workers with respiratory symptoms.
Scandinavian Journal of Work, Environment and Health, 22(1):62-65, 1996. (22 references)
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