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(c) 2016 Jon L Gelman, All Rights Reserved.

Thursday, September 4, 2014

Pulmonary Fibrosis Associated with Aluminum Trihydrate (Corian) Dust


Today's post is shared from nejm.org/

To the Editor:A 64-year-old man who was an exercise physiologist was noted to have clinical and physiological features of idiopathic pulmonary fibrosis.1 On detailed questioning, he stated that he had ground, machined, drilled, and sanded Corian (a solid-surface material composed of acrylic polymer and aluminum trihydrate2) in his garage for about 16 years (Figure 1A FIGURE 1Findings Indicating a Potential Causal Relationship between Corian Dust and Pulmonary Fibrosis in the Patient.). He had typical clinical features of idiopathic pulmonary fibrosis and radiographic features of usual interstitial pneumonia, and a surgical lung biopsy showed histologic features of usual interstitial pneumonia (Figure 1B and 1C), a hallmark of idiopathic pulmonary fibrosis. Prompted by an elicited history of exposure and findings on polarized light microscopy (Figure 1D), we conducted further tissue analyses that showed aluminum trihydroxide in the fibrotic lung (Figure 1E and 1F); this finding provided support for a potential causal relationship between the Corian dust and pulmonary fibrosis. Although the patient avoided further exposure to Corian dust, his respiratory status slowly deteriorated over the next 7 years and he died from respiratory failure secondary to pulmonary fibrosis. High-resolution computed tomographic images of the chest showed an overall pattern that was consistent with end-stage usual interstitial pneumonia. At autopsy, the lungs were small; aluminum trihydroxide was detected in the fibrotic lungs.



Although the evidence from this single case is circumstantial, the history of exposure, analyses of the lung tissue, and the sample of dust obtained from the patient's environment are consistent with a causal association. Pulmonary fibrosis has been associated with metal dusts and aluminum.3,4 A meta-analysis of six case–control studies of idiopathic pulmonary fibrosis showed a significant association between metal exposures and this condition.5 Without the elicited history of exposure to Corian dust and the finding of birefringent particles in the tissue, we would not have considered Corian dust as a potential cause of pulmonary fibrosis and the patient would have been considered to have idiopathic pulmonary fibrosis.1 Although the findings from this case do not confirm causality, until further data to support or refute the association are available, inquiry into each patient's occupational and environmental exposures should be made when considering a diagnosis of idiopathic pulmonary fibrosis.

Ganesh Raghu, M.D.
Bridget F. Collins, M.D.
University of Washington Center for Interstitial Lung Diseases, Seattle, WA
graghu@uw.edu

Daniel Xia, M.D.
Beth Israel Deaconess Medical Center, Boston, MA

Rodney Schmidt, M.D., Ph.D.
University of Washington Center for Interstitial Lung Diseases, Seattle, WA

Jerrold L. Abraham, M.D.
State University of New York Upstate Medical University, Syracuse, NY

Disclosure forms provided by the authors are available with the full text of this letter at NEJM.org.

This letter was updated on May 29, 2014, at NEJM.org.

Click here to read more: N Engl J Med 2014; 370:2154-2157 May 29, 2014 DOI: 10.1056/NEJMc1404786