Tuberc Respir Dis.  2012 Feb;72(2):223-227.

A Case of Welder's Lung Disease and Concurred Non-Tuberculotic Mycobacterial Infection Confirmed with Thoracoscopic Lung Biopsy

• Kim JH
• Park YJ
• Park KH
• Kwon SS
• Kim YH

Abstract

Pulmonary siderosis, or Welder's lung disease is an occupational lung disease caused by iron-inhalation. Diagnosis of pulmonary siderosis is based on occupational history of the patient, radiologic findings, and pathologic findings of iron-laden macrophages within lung tissue or broncho-alveolar lavage fluid. We observed a case of a 43 years-old welder diagnosed with pulmonary siderosis via thoracoscopic lung biopsy. Sputum culture along with pathology also identified a non-tuberculotic mycobacterial infection with a sputum culture and the pathologic findings. The patient was treated with anti-tubercular medication and cessation of iron-exposure. And his condition improved within a few months.

Keyword

Hemosiderosis; Pneumoconiosis; Mycobacterium Infections, Nontuberculous; Thoracic Surgery, Video-Assisted

MeSH Terms

Biopsy
Hemosiderosis
Humans
Lung
Lung Diseases
Macrophages
Mycobacterium Infections, Nontuberculous
Pneumoconiosis
Siderosis
Sputum
Therapeutic Irrigation
Thoracic Surgery, Video-Assisted

Figure

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  Figure 1 Chest PA shows diffuse reticulo-nodular opacities on bilateral lung field. PA: posterior anterior.

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  Figure 2 Chest CT shows 2.2×1.9 cm sized cavitary lesion in left upper lobe and fibrous scar in right upper lobe. It also shows widespread centri-lobular nodules with ground glass opacities. CT: computed tomography.

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  Figure 3 Broncho-alveolar lavage fluid showed macrophages containing iron pigment. Iron pigments represented brown color in Periodic acid-Schiff stain, and deep blue color in Prussian blue stain (A, Periodic acid-Schiff stain, ×800; B, Prussian blue stain, ×800).

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  Figure 4 (A) Brown pigmentation, iron compound deposited in the alveolar space and interstitial tissue (HE stain, ×400). (B) Many macrophages in the alveolar space shows blue cytoplasmic pigmentations (iron-particles; Prussian blue stain, ×400). (C) and (D), chronic granulomatous inflammation with multi-nucleated giant cells suggested mycobacterial infection (C, HE stain, ×40; D, HE stain, ×200).

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