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Chest. 2012 Jun;141(6):1512-1521. doi: 10.1378/chest.11-1880. Epub 2011 Dec 29.

Indium lung disease.

Author information

1
Division of Respiratory Disease Studies, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV. Electronic address: kcummings@cdc.gov.
2
Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan.
3
Occupational Respiratory Disease Center, Toyama Rosai Hospital, Toyama, Japan.
4
Department of Medicine, Nikko Memorial Hospital, Hitachi, Japan.
5
Department of Respiratory Medicine, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.
6
Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC.
7
Department of Pathology, Duke University Medical Center, Durham, NC.
8
Department of Pathology, Tokyo National Hospital, Tokyo, Japan.
9
Department of Radiology, West Virginia University School of Medicine, Morgantown, WV.
10
Division of Pulmonary, Critical Care, and Sleep Medicine, University of Cincinnati College of Medicine, Cincinnati, OH.
11
Division of Respiratory Disease Studies, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV.
12
Division of Respiratory Disease Studies, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA.

Abstract

BACKGROUND:

Reports of pulmonary fibrosis, emphysema, and, more recently, pulmonary alveolar proteinosis (PAP) in indium workers suggested that workplace exposure to indium compounds caused several different lung diseases.

METHODS:

To better understand the pathogenesis and natural history of indium lung disease, a detailed, systematic, multidisciplinary analysis of clinical, histopathologic, radiologic, and epidemiologic data for all reported cases and workplaces was undertaken.

RESULTS:

Ten men (median age, 35 years) who produced, used, or reclaimed indium compounds were diagnosed with interstitial lung disease 4-13 years after first exposure (n = 7) or PAP 1-2 years after first exposure (n = 3). Common pulmonary histopathologic features in these patients included intraalveolar exudate typical of alveolar proteinosis (n = 9), cholesterol clefts and granulomas (n = 10), and fibrosis (n = 9). Two patients with interstitial lung disease had pneumothoraces. Lung disease progressed following cessation of exposure in most patients and was fatal in two. Radiographic data revealed that two patients with PAP subsequently developed fibrosis and one also developed emphysematous changes. Epidemiologic investigations demonstrated the potential for exposure to respirable particles and an excess of lung abnormalities among coworkers.

CONCLUSIONS:

Occupational exposure to indium compounds was associated with PAP, cholesterol ester crystals and granulomas, pulmonary fibrosis, emphysema, and pneumothoraces. The available evidence suggests exposure to indium compounds causes a novel lung disease that may begin with PAP and progress to include fibrosis and emphysema, and, in some cases, premature death. Prospective studies are needed to better define the natural history and prognosis of this emerging lung disease and identify effective prevention strategies.

PMID:
22207675
PMCID:
PMC3367484
DOI:
10.1378/chest.11-1880
[Indexed for MEDLINE]
Free PMC Article

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