PULMONARY ALVEOLAR PROTEINOSIS IN A PAINTER WITH ELEVATED PULMONARY CONCENTRATIONS OF TITANIUM

We present the case of a professional painter who developed pulmonary alveolar proteinosis (PAP) with severe respiratory failure. He require d total bilateral pulmonary lavage on two separate occasions, 3 months apart. Quantitative analysis of particles found in lung tissues obtai ned by open lung biopsies demonstrated the presence of titanium (60-12 9 million particles of titanium per cm(3) of lung tissue). This report extends previous results from animal studies that demonstrated develo pment bf alveolar proteinosis in rats following exposure to titanium. It has been proposed that the overwhelming impairment of the normal cl earance mechanisms of the lung by particles of titanium is one of the possible mechanisms responsible for the development of this lung disea se. We suggest that a similar mechanism occurred in our patient and th at titanium should be recognized as a potential cause of PAP in humans .