DIFFUSE PULMONARY HEMOSIDEROSIS AFTER EXPOSURE TO PESTICIDES - A CASE-REPORT

This report describes the clinical, radiological, microscopical and li gandohistochemical findings in a 17-year-old woman who suffered from a n acute onset of pulmonary hemosiderosis after inhalation of pesticide s used for the cultivation of strawberries. She complained of headache , dyspnea, rhinitis, weakness and recurrent severe hemoptysis. Chest r adiographs revealed bilateral patchy infiltrates, predominantly in the lower parts of both lungs. The consecutive severe anemia was treated by multiple blood transfusions which were repeated every 4-5 days. Ope n lung biopsies displayed signs of diffuse hemorrhage with hemosiderin -loaded macrophages, some hyaline membranes, focal fibroid deposits wi th intermingled histiocytes, mild interstitial fibrosis and focal intr a-alveolar calcified bodies surrounded by foreign body giant cells. An alysis of endogenous lectins failed to demonstrate expression of bindi ng capacities for maltose, fucose, mannose; lactose and sialic acid. N either binding capacities for the macrophage-migration-inhibitory fact or nor its presence, as analyzed by labeled sarcolectin, could be dete cted histochemically. The light microscopical findings are consistent with a longer-lasting diffuse pulmonary hemosiderosis; the presence of calcified bodies and foreign body giant cells (including the ligandoh istochemical data) argues for a causal role of inhaled substances. The patient's clinical course improved after cyclophosphamide treatment, which restored her ability to work and released her from the need for recurrent blood transfusions.