This case report describes a case of spontaneous pneumothorax in a met
al grinder that failed to resolve with medical management. A lung biop
sy taken during the subsequent thoracotomy revealed changes that were
characteristic of giant cell interstitial pneumonia, as seen in hard m
etal disease. Pneumothorax has been described in many forms of interst
itial lung disease but not in this type of occupational disease. Aware
ness of this possible association can result in: (1) the removal of an
affected worker from his adverse work environment before advanced dis
ease develops; and (2) the safe control of the work environment, to th
e advantage of other similarly exposed workers.