Hard metal alveolitis accompanied by rheumatoid arthritis

Hard metal lung diseases (HML) are rare, and complex to diagnose. We descri be the case of a patient with allergic alveolitis accompanied by rheumatoid arthritis. A sharpener of hard metal by trade, our patient was a 45-year o ld, nonsmoking Caucasian female who experienced symptoms of cough and phleg m, and dyspnea on exertion. Preliminary lung findings were inspiratory rate s in both basal areas, decreased diffusion capacity and a radiological pict ure resembling sarcoidosis, A high-resolution computed tomography scan indi cated patchy alveolitis as well. An open lung biopsy revealed nonnecrotizin g granulomas consisting of epitheloid cells and surrounded by lymphocytes, plasma cells and a few eosinophils. These cells also occupied the thickened alveolar interstitium, Macrophages in the alveolar spaces, some of them mu ltinuclear, contained dust particles. Hard metal alveolitis is clinically w ell known and, in this patient, has been described histologically. After th e patient had quit working with hard metal and following corticosteroid the rapy, pulmonary symptoms and signs were relieved. During this recovery peri od, however, she contracted rheumatoid arthritis. Copyright (C) 2000 S. Kar ger AG, Basel.