HARD METAL EXPOSURENONGIANT CELL INTERSTITIAL PNEUMONIA CASE

Yıl 2014, Cilt: 28 Sayı: 3, 195 - 198, 01.12.2014

Erkan Akar Taşkın Erkin Üresin Fatin Tolga Cengiz

Öz

Giant cell interstitial pneumonia, caused by exposure to hard metals usually is a form of pulmonary fibrosis. Most of the cases are seen after exposure to hard metals such as cobalt and tungsten. Nonetheless the certain mechanism of intersitital pneumonia caused by hard metals is not known. Fifty years old office worker male, presented with chest pain, dry cough, shortness of breath since three months. He had a smoking history of 30 packs/year and did not have any hard metal exposure. Bronchoscopy was performed after the demonstration of a hypodense lesion on thorax computed tomography. There was not any endobronchial lesion. Pozitron emission tomography was done followed by mediastinoscopy and thoracotomy. The patient was diagnosed as “giant cell interstitial pneumonia” with an open lung biopsy. The patient receiving steroid treatment is discussed with clinical, radiological findings under the light of the literature.

Anahtar Kelimeler

Hard metal exposure, lung, giantcellinterstitialpneumonia

SERT METAL MARUZİYETİ OLMAYAN DEV HÜCRELİ İNTERSTİSYELPNÖMONİ OLGUSU

Öz

Dev hücreli interstisyel pnömoni, genellikle sert metallere maruziyetin neden olduğu bir pulmoner fibroz formudur. Olguların çoğu kobalt, tungsten gibi sert metallere maruziyet sonrası görülür. Bununla birlikte, sert metal maruziyetinin dev hücreli interstisyel pnömoniye yol açtığı kesin mekanizma bilinmemektedir. Elli yaşında, ofis çalışanı erkek hastada yaklaşık üç aydan beri başlayan göğüs ağrısı, kuru öksürük, nefes darlığı, şikâyetleri mevcuttu. Mesleki sert metal maruziyetinin olmadığı hastada, 30 paket/yıl sigara içme öyküsü vardı. Toraks bilgisayarlı tomografisin de, orta lobda hipodens lezyon görülmesi üzerine bronkoskopi yapıldı. Endobronşial lezyon görülmeyen hastaya PET-CT çektirilerek mediastinoskopi ve sonrasında torakotomi yapıldı. Açık akciğer biyopsisinde dev hücreli interstisiyel pnömoni tanısı konuldu. Steroid tedavisi alan olgu, klinik, radyolojik ve literatür bilgileri altında tartışılmıştır.

Anahtar Kelimeler

Sert metal maruziyeti, akciğer, dev hücreli interstisyelpnömoni

Kaynakça

• 1. Ohari NP, Sciurba FC, Owens GR, Hodgson MJ, Yousem SA: Giant cell interstitial pneumonia and hard-metal pneumoconiosis. Am J SurgPathol 1989; 13: 581–7.
• 2. Liebow AA, Carrington CB: Alveolardiseases– The interstitial pneumonias; in Simon M, Potchen EJ, Le May M (eds): Frontiers of Pulmonary Radiology. New York, Grune& Stratton, 1969, pp 102–41.
• 3. Sundaram P, Agarwal K, Mandke JV, Joshi JM: Giant cell pneumoniti sinduced by cobalt. Indian J Chest Dis Allied Sci 2001; 43: 47–9.
• 4. Nemery B, Verbeken EK, Demedts M. Giantcel linterstitialpneumonia (hard metal lung disease, cobalt lung). Semin Respir Crit CareMed 2001; 22: 435-8.
• 5. Potolicchio I, Mosconi G, Forni A, Nemery B, Seghizzi P, Sorrentino R. Susceptibility to hard metal lung disease is strong ly associated with thepresence of glutamate 69 in HLA-DP beta chain. Eur JImmunol 1997; 27: 2741-3.
• 6. Kelleher P, Pacheco K, Newman LS. Inorganic dust pneumonias: the metal-related parenchy mal disorders. Environ Health Perspect 2000; 108: 685-96.
• 7. Travis WD, Colby TV, Koss MN, Rosado-deChristenson ML, Müler NL, King TE, eds. Nonneo plastic disorders of the lower respiratory tract. Washington: American Registry of Pathology and the Armed Forces Institute of Pathology, 2002: 840-2.
• 8. Okuno K, Kobayashi K, Kotani Y, Ohnishi H, Ohbayashi C, Nishimura Y. A case of hard metal lung diseaseresembling a hyper sensitive pneumonia in radiological images. Intern Med 2010; 49: 1185-9.