A case report of pulmonary tuberculosis with metal-induced diffuse lung disease

L. Wang*^a (Dr), J. Xia^a (Dr), L. Wang^a (Dr), J. Ye^a (Dr)

^a Department of Pulmonary Medicine, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, CHINA

* wangliusheng0201@126.com

Purpose

The purpose of this report is to reveal the value of bronchoscopy in the diagnosis of metal-induced diffuse lung disease complicated with pulmonary tuberculosis.

Methods

A case of pulmonary tuberculosis complicated with metal-induced diffuse lung disease was retrospectively analyzed. The medical history, clinical manifestations, auxiliary examination and diagnosis and treatment process were analyzed. Review relevant literature to summarize the value of bronchoscopy in diagnosis and treatment..

Results

The patient worked as an steel galvanizing and had a smoking history of 10 pack* years. Due to physical examination, chest CT showed diffuse lung lesions, right lung masses, cavities (Fig 1), and multiple nodules. No shortness of breath, fever, cough, chest pain symptoms. Pulmonary function test results: VCmax 99%, FEV1/FVC 83%, MEF75 75%, MEF50 58%, MEF25 36%, MVV 85%, TLCO 87% . Bronchoscopy biopsy showed granulomatous inflammation with necrosis in the right lung and positive staining for acid-fast bacilli (Fig 2A). A biopsy of the left lower lung was positive for Prussian blue staining, confirming the deposition of iron-containing substances in the alveolar space (Fig 2B).

Conclusions

The diagnosis of metal-induced allergic diseases is always dependent on the level of knowledge of the physician. With the help of bronchoscopy, the components of metal that causing allergic alveolitis can be identified, and it is helpful for the diagnosis of coexisting diseases.

Disclosure of funding source(s): none