Abstract
Giant cell interstitial pneumonia, a synonym of (for) hard metal pneumoconiosis,
is a unique form of pulmonary fibrosis resulting from an exposure to hard metal dust. A case
of biopsy-proved giant cell interstitial pneumonia in the absence of appropriate
history of exposure to hard metal dust is reported. The patient presented with clinical
features of chronic interstitial lung disease or idiopathic pulmonary fibrosis. He worked in
a chemical laboratory at a fertilizer plant(,)where he had been exposed to various chemicals
such as benzene and toluene. He denied having any other hobby in his house or job at work
which may have exposed him hard metal dust(.) High-resolution CT scan revealed multi-lobar
distribution of ground glass opacity with peripheral and basal lung predominance. The
retrieved fluid of bronchoalveolar lavage contained asbestos fiber and showed neutrophil
predominance. Surgical lung biopsy was performed for a definite diagnosis. Lung specimen
showed alveolar infiltration of numerous multinucleated giant cells with mild interstitial
fibrosis. Upon detailed examination of the lung tissue, one asbestos body was found.
An analysis for mineral contents in lung tissue was performed. Compared to with the control
specimen, the amount of cobalt and several hard metal components in the lung tissue of this
patient was ten times higher. We speculated that the inconsistency between occupational
history and the findings of pathologic and mineralogical analyses could be explained by
the difference in individual immunologic reactivity to hard metal dust despite the relatively
small amount of unrecognized environmental exposure (ED: It's hard to understand what
this phrase is trying to say).