• Tuberculosis and Respiratory Diseases
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• v.57 no.3
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• pp.273-277
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• 2004

Methotrexate is commonly used in rheumatoid arthritis as an anti-inflammatory agent, but treatment with methotrexate can lead to severe side effects, especially pulmonary complication. Interstitial pneumonitis is one of the most important pulmonary adverse effects of methotrexate and most patient present with a subacute febrile illness and peripheral eosinophilia is seen in about a half of patients. Almost all patients have abnormal chest roentgenograms and bibasilar interstitial infiltration with alveolar pulmonary consolidations is the most characteristic finding. Interstitial inflammation with mononuclear cell infiltration is a characteristic pathologic feature and findings that suggest acute hypersensitivity pneumonitis, such as bronchiolitis, granuloma formation with giant cells, and infiltration with eosinophils are often present. Methotrexate-induced pneumonitis is a potentially life threatening and unpredictable complication but it is difficult to make a definite diagnosis in the absence of high index of clinical suspicion. Early recognition and appropriate management may avoid the serious outcome. Herein we report a case of methotrexate-induced pneumonitis in a patient with rheumatoid arthritis.

• Tuberculosis and Respiratory Diseases
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• v.76 no.2
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• pp.75-79
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• 2014

Trichloroethylene (TCE) is a toxic chemical commonly used as a degreasing agent, and it is usually found in a colorless or blue liquid form. TCE has a sweet, chloroform-like odor, and this volatile chlorinated organic chemical can cause toxic hepatitis, neurophysiological disorders, skin disorders, and hypersensitivity syndromes. However, the hypersensitivity pneumonitis (HP) attributed to TCE has rarely been reported. We hereby describe a case of HP associated with TCE in a 29-year-old man who was employed as a lead welder at a computer repair center. He was installing the capacitors on computer chip boards and had been wiped down with TCE. He was admitted to our hospital with complaints of dry coughs, night sweats, and weight losses for the past two months. HP due to TCE exposure was being suspected due to his occupational history, and the results of a video-associated thoracoscopic biopsy confirmed the suspicions. Symptoms have resolved after the steroid pulse therapy and his occupational change. TCE should be taken into consideration as a potential trigger of HP. Early recognition and avoidance of the TCE exposure in the future is important for the treatment of TCE induced HP.

• Korean Journal of Radiology
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• v.24 no.8
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• pp.795-806
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• 2023

Occupational lung diseases (OLD) are a group of preventable conditions caused by noxious inhalation exposure in the workplace. Workers in various industries are at a higher risk of developing OLD. Despite regulations contributing to a decreased incidence, OLD remain among the most frequently diagnosed work-related conditions, contributing to significant morbidity and mortality. A multidisciplinary discussion (MDD) is necessary for a timely diagnosis. Imaging, particularly computed tomography, plays a central role in diagnosing OLD and excluding other inhalational lung diseases. OLD can be broadly classified into fibrotic and non-fibrotic forms. Imaging reflects variable degrees of inflammation and fibrosis involving the airways, parenchyma, and pleura. Common manifestations include classical pneumoconioses, chronic granulomatous diseases (CGD), and small and large airway diseases. Imaging is influenced by the type of inciting exposure. The findings of airway disease may be subtle or solely uncovered upon expiration. High-resolution chest CT, including expiratory-phase imaging, should be performed in all patients with suspected OLD. Radiologists should familiarize themselves with these imaging features to improve diagnostic accuracy.

• Tuberculosis and Respiratory Diseases
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• v.70 no.1
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• pp.43-50
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• 2011

Background: Open lung biopsy is used for diagnosis of diffuse infiltrative lung diseases (DILD), but it is invasive and relatively expensive procedure. Fluoroscopy-guided cutting needle lung biopsy (FCNLB) has merits of avoidance of admission and rapid diagnosis. But diagnostic accuracy and safety were not well known in the diagnosis of DILD. Methods: We included 52 patients (37 men, 15 women) having DILD on HRCT with dyspnea, except the patients who could be confidently diagnosed with clinical and HRCT findings. FCNLB was performed using 16G Ace cut needle (length 1.5 cm, diameter 2 mm) at the area of most active lesion on HRCT. Final diagnoses were made by the consensus. Results: The mean interval between the HRCT and FCNLB was 4.5 days. Most cases were performed one biopsy during 5~10 minutes. Specific diagnosis was obtained in 43 of 52 biopsies (83%). The most common diagnosis was nonspecific interstitial pneumonia (11 cases) and followed by cryptogenic organizing pneumonia (7 cases), diffuse alveolar hemorrhage and usual interstitial pneumonia (5 cases in each), hypersensitivity pneumonitis (3 cases), tuberculosis and drug induced interstitial pneumonitis (2 cases in each), the others are in one respectively. Mild complication was developed in 9 patients (8 pneumothorax, 1 hemoptysis). Most of complications were regressed without treatment except one case with chest tube insertion for pneumothorax. Conclusion: Fluoroscopy-guided 16 G cutting needle lung biopsy was an useful method for the diagnosis of DILD.

• Safety and Health at Work
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• v.3 no.1
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• pp.1-10
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• 2012

The aim of this review was to assess current knowledge related to the occupational exposure limit (OEL) for fluid aerosols including either mineral or chemical oil that are generated in metalworking operations, and to discuss whether their OEL can be appropriately used to prevent several health risks that may vary among metalworking fluid (MWF) types. The OEL (time-weighted average; 5 mg/$m^3$, short-term exposure limit ; 15 mg/$m^3$) has been applied to MWF aerosols without consideration of different fluid aerosol-size fractions. The OEL, is also based on the assumption that there are no significant differences in risk among fluid types, which may be contentious. Particularly, the health risks from exposure to water-soluble fluids may not have been sufficiently considered. Although adoption of The National Institute for Occupational Safety and Health's recommended exposure limit for MWF aerosol (0.5 mg/$m^3$ ) would be an effective step towards minimizing and evaluating the upper respiratory irritation that may be caused by neat or diluted MWF, this would fail to address the hazards (e.g., asthma and hypersensitivity pneumonitis) caused by microbial contaminants generated only by the use of water-soluble fluids. The absence of an OEL for the water-soluble fluids used in approximately 80-90 % of all applicants may result in limitations of the protection from health risks caused by exposure to those fluids.

• Journal of Korean Society of Occupational and Environmental Hygiene
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• v.17 no.1
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• pp.1-12
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• 2007

We have reviewed all cases and epidemiological studies that have reported the association between worker's exposure to metalworking fluids(MWF) and non-malignant respiratory diseases. The followings are main conclusions we critically reviewed. Exposure to MWF was believed to be significantly related to the risk of cough and phlegm. Relative risk caused by straight MWF was found to be higher in exposure to straight MWF than water-soluble MWF. We also found that exposure to water-soluble MWF significantly caused hypersensitivity pneumonitis (HP) and occupational asthma. The main culprits that cause the development of HP and asthma are believed to be microbes contaminated in MWF, ethanolamine and biocides. HP and asthma could be developed at even exposure to lower than $0.5mg/m^3$, exposure level recommended by NIOSH. Most epidemiological studies have reported that relationship between chronic bronchitis and exposure to MWF was significant. Although there were several studies that suggested the significant association between exposure to MWF and the development of rhinitis and sinusitis, we could not conclude the causal relationship because of lack of evidences.

• Journal of Environmental Health Sciences
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• v.32 no.5 s.92
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• pp.412-417
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• 2006

A self-administrated non-malignant respiratory symptoms questionnaire was sent to 1,099 citizens who take subway running in Seoul city. Symptom prevalence rate was high: 70.6% of subjects reported 'chest tightness', 43.4%, 'dysphnea'; 76.2%, 'dry cough'; 49.5%, 'runny nose'; 94.4%, 'drowsiness' when they take subway. The groups responding significant higher respiratory and drowsiness symptoms were 'young passengers' (vs elderly passengers), 'the female' (vs male), 'using subway everyday' (vs often), 'using subway for rush-hour time' (vs other than rush-hour), 'using transfer subway' (no transfer), 'using underground track' (vs ground track). Logistic. regression model was employed to find personal and subway characteristics affecting non-malignant respiratory symptoms. This study concluded that respiratory diseases history such as asthma, rhinitis, sinusitis, hypersensitivity pneumonitis significantly affect 'dry cough' and 'runny nose'. Thus, passengers with respiratory diseases history shows 2.8 times greater 'dry cough' than and 3.4 times greater 'runny nose' than those passengers without respiratory diseases history felt. This results indicated that several measures have to take to protect sensitive groups such as passengers with respiratory diseases, children and elderly people. Also passenger who use to transfer shows 1.7 times higher runny nose symptoms than that passenger who do not transfer felt.

• Toxicological Research
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• v.17 no.3
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• pp.163-165
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• 2001

A patient,58 years of age, with suspected 0/l pneumoconiosis since 1993, complained of a dry cough and exertioning dyspnea for 6 months. He had worked in an asbestos company for more than 20 years from 1974. He was subsequently diagnosed with an interstitial lung disease during an annual special health check-up for asbestos workers. h chest X-ray showed an interstitial lung disease and high-resolution computed tomography (HRCT) showed a round opaque asbestosis with chronic hypersensitivity pneumonitis. A pulmonary function test indicated that the patient had a mild restrictive lung disease with FEV1 1.67 litters and 82% FEVl/FVC. The bronchoalveloar larvage fluid included many asbestos bodies, indicating previous exposure to asbestos. Transmission electron microscopy (TEM) using an energy dispersive X-ray analyzer (EDX) revealed many asbestos bodies consisting of mainly crocidolite fibers (6,071$\times$$10^6$fibers/g of dry lung). The patient had an unusually high asbestos content of 6,112$\times$$10^6$ asbestos fibers/9 of dry lung.

• Tuberculosis and Respiratory Diseases
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• v.77 no.3
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• pp.145-148
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• 2014

Valproic acid is one of the most common antiepileptic drugs used for the treatment of several seizure disorders. A 20-year-old man presented with a sudden decline of consciousness. He had a neurosurgery operation for intracranial and intraventricular hemorrhage. Following surgery, antiepileptic medication was administered to the patient in order to control his seizure events. On valproic acid treatment, he began to complain of fever and dyspnea. His symptoms persisted despite receiving empirical antibiotic treatment. All diagnostic tests for infectious causes were negative. A high-resolution computed tomography scan of the chest revealed predominantly dependent consolidation and ground-glass opacities in both lower lobes. The primary differential was drug associated with interstitial lung disease. Therefore, we discontinued valproic acid treatment and began methylprednisolone treatment. His symptoms and radiologic findings had significantly improved after receiving steroid therapy. We propose that clinicians should be made aware of the potential for valproic acid to induce lung injury.

• Journal of Korean Society of Occupational and Environmental Hygiene
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• v.23 no.3
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• pp.169-176
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• 2013

Objectives: The aim of this study is to critically review the health effects of not only direct exposure to biocide, but also indirect exposure to by-product hazardous agents generated through the use of biocide in metalworking operations. Methods: An extensive literature review was conducted of studies reporting on respiratory disease cases, particularly hypersensitivity pneumonitis (HP), in environments using water-soluble metalworking fluids (MWFs). Keyword search terms included 'metalworking fluids', 'machining fluids', 'metalworking operation' 'machining operation' and 'biocide', which were also used in combination. Additional articles were identified in references cited in the articles reviewed. Results: Several of the field, epidemiological and experimental studies reviewed assumed that the symptoms and signs typical of HP developed in machinists who handled water-soluble MWF could be caused by inhalation exposure to nontuberculous mycobacteria (NTM). Most NTM are known to be not only resistant to both biocide and disinfectant, but also to have acid-fast cell walls that are highly antigenic. The presence or persistence of the Mycobacterium species, referred to as NTM, in metalworking fluid-using operations may be caused by NTM contamination in either the natural water or tap water that is used to dilute the base oil and additives for water-soluble MWFs. This hypothesis that NTM contamination in water-soluble MWFs is a causative agent of HP has high biologic plausibility, such as antigenic property, hydrophobicity and small diameter (< 5 um). Conclusions: Aerosolized mycobacteria colonized from MWF are likely to be causing the HP. Inhalation exposure to mycobacteria should be considered as a possible cause for the development of HP.