PDF
ePub
Citation
Print
Abstract
The Inhalation of certain freshly formed metal oxides can cause metal fume fever, which is an acute, self-limiting, flu-like illness. The most common cause of this syndrome is the inhalation of zinc oxide. The inhalation of zinc oxide can lead to tracheobronchiolitis, chemical pulmonary edema or to respiratory failure and acute respiratory distress syndrome(ARDS). We encountered a 43-years-old man who developed severe dyspnea after inhaling of zinc oxide while working for 5 hours in a closed space. He was diagnosed with ARDS and was treated successfully with glucocorticoid. We report a case of ARDS caused by the inhalation of zinc fumes.
Figures and Tables
Figure 1
(A) On admission, chest radiography shows diffuse consolidations and ground glass opacities in the both lung fields. (B) High resolution computed tomography of the chest shows consolidations, ground glass opacities and ill defined centrilobular nodules in the both lung.
Figure 2
On hospital day 2, the chest radiography reveals improvement of the consolidations in the both lung fields.
Figure 3
On discharge, the chest radiography shows nearly improved consolidations in the both lung. There are fibrotic changes in the right upper lung field and bullous emphysema in the left middle lung field.
Figure 4
(A) On the chest radiography after 4 months, the consolidations and ground glass opacities had been disappeared. (B) High resolution computed tomography scan of the chest, after 4 months, shows complete resolution of the consolidations and ground glass opacities. Mild paraseptal emphysemas in the superior segments of the both lower lobes are revealed.
References
1. Elinder CG, Zenz C. Zenz C, Dickerson OB, Horvath EP, editors. Chapter 46. Other Metals and their compounds. Occupational medicine. 1994. 3rd ed. St. Louis, Missouri: Mosby, Inc.;595–616.
2. Evans EH. Casualties following exposure to zinc chloride smoke. Lancet. 1945. 2:368–370.
3. Hjortso E, Qvist J, Bud MI, Thomsen JL, Andersen JB, Wilberg-Jorgensen F, et al. ARDS after accidental inhalation of zinc chloride smoke. Intensive Care Med. 1998. 14:17–24.
4. Lim HS, Cheong HK. A case of metal fume fever associated with copper fume in a welder. Korean J Prev Med. 1998. 31:414–423.
5. Rose CS. Rom WN, editor. Inhalation fevers. Environmental and occupational medicine. 1992. 2nd ed. Boston: Little, Brown & Co.;376–377.
6. Balmes JR. LaDou J, editor. Chapter 20. Occupational lung diseases. Current occupational & environmental medicine. 2004. 3rd ed. Lange: McGraw-Hill, Inc.;320–344.
7. Anseline P. Zinc fume fever. Med J Aust. 1972. 2:316–318.
8. Pettila V, Takkunen O, Tukiainen P. Zinc chloride smoke inhalation: a rare cause of severe acute respiratory distress syndrome. Intensive Care Med. 2000. 26:215–217.
9. Hsu HH, Tzao C, Chang WC, Wu CP, Tung HJ, Chen CY, et al. Zinc chloride (smoke bomb) inhalation lung injury: clinical presentations, high -resolution CT findings, and pulmonary function test results. Chest. 2005. 127:2064–2071.
10. Homma S, Jones R, Qvist J, Zapol WM, Reid L. Pulmonary vascular lesions in adult respiratory distress syndrome caused by inhalation of zinc chloride smoke: a morphometric study. Hum Pathol. 1992. 23:45–50.
11. Kuschner WG, D'Alessandro A, Wong H, Blanc PD. Early pulmonary cytokine responses to zinc oxide fume inhalation. Environ Res. 1997. 75:7–11.
12. Libby P, Friedman GB, Salomon RN. Cytokines as modulators of cell proliferation in fibrotic disease. Am Rev Respir Dis. 1989. 140:1114–1117.
13. Lefering R, Neugebauer EA. Steroid controversy in sepsis and septic shock: a meta-analysis. Crit Care Med. 1995. 23:1294–1303.
XML Download