Berylliosis in a 56-year-old welder

Abstract

A 56-year-old female presented to her family doctor with insidious shortness of breath that had progressed over several months, from exertional dyspnea to shortness of breath at rest. She had no fever, night sweats, weight loss nor hemoptysis, and was otherwise asymptomatic. At the time of presentation, her medical history included sleep apnea and a mood disorder, which was being treated with a serotonin–norepinephrine reuptake inhibitor. She had never smoked. She had been working as a welder for more than 3 decades in the oil and gas sector. She used various welding methods and metals, including some self-described “exotic metals,” in indoor and outdoor facilities with poor ventilation. She wore respirators infrequently. Her family doctor referred her to a respirologist at the regional hospital for further investigations (Table 1). Gaps in time between investigations occurred in part because the patient moved among provinces during management. We ordered a pulmonary function test, which showed mild diffusion capacity impairment, commensurate with numerous possible diagnoses (Table 2). The patient’s complete blood count, coagulation, liver function, electrolytes, renal function and thyroid-stimulating hormone levels were normal. A chest radiograph showed nonspecific subsegmental atelectasis in the left lower lung zone. A computed tomography scan of the chest showed multiple 2- to 3-mm noncalcified pulmonary nodules, notably one 18-mm, ill-defined, ground-glass nodule in the left lower lobe and one 7-mm nodule in the right upper lobe. Hilar and mediastinal lymph nodes were slightly prominent but not enlarged beyond normal limits. We saw no reticular markings