A CASE OF SARCOIDOSIS THAT DEVELOPED 3 YEARS AFTER THE ONSET OF HARD METAL ASTHMA

A 23-year-old man who worked at a hard metal factory from 1988 had dev eloped bronchial asthma in 1990. He was diagnosed as having bronchial asthma by inhalation challenge with cobalt. He never developed a sever e attack after that by avoiding inhalation of cobalt. In 1993, he deve loped iridocyclitis, and his chest radiograph showed bilateral hilar l ymph node swelling. He was diagnosed as having sarcoidosis with pathol ogical certainty and an increased serum angiotensin-converting enzyme (ACE) level. On second admission, an inhalational challenge with cobal t resulted in no significant decrease of FEV1. Cobalt is well known to cause occupational asthma and other interstitial lung diseases. Altho ugh we could not get clear evidence suggesting an association between the sarcoidosis and his history of cobalt exposure, there is a possibi lity that changes in the immune reaction to cobalt might explain the i mprovement of asthma followed by sarcoidosis in this case. (C) 1998 Wi ley-Liss, Inc.