We report a case of subacute extrinsic allergic alveolitis due to occupational exposure to Penicillium spores in a 43-years old female working in a salami factory that developed a dry cough that gradually evolved to productive cough, shortness of breath, fatigue and body weight loss. Over time she complained of several episodes of flu-like symptoms that worsen around the periods in which she removed the excess mould from the surface of the salami a work. On admission, physical examination revealed crackles in both lungs on chest auscultation, pulmonary function tests showed a restrictive pattern with reduced diffusion capacity of carbon monoxide and imagistic tests identified centrilobular nodules of ground-glass opacity in both lung fields, particularly in the upper lobes. BAL showed lymphocytosis associated with neutrophilia, a pattern consistent with EAA. She was put on systemic corticosteroids and ceased exposure. The patient was compliant and after one year her medication was gradually withdrawn and in the absence of exposure, symptoms and pulmonary function normalized. The reported case had a favorable outcome due to relatively early detection and absence of exposure. Currently, the identification and removal of the causative agent remains the cornerstone of prevention, evolution and prognosis.
Caplan’s syndrome, known as rheumatoid pneumoconiosis, was first described by Anthony Caplan in 1953, who identified a rare lung disorder found in coal mine workers with rheumatoid arthritis. Although Caplan’s syndrome was found in patients with a variety of pneumoconioses, it mostly affects individuals with long exposure to crystalline silica. We present a case of Caplan’s syndrome in a patient with advanced stage of rheumatoid arthritis and silicosis.
Acrylates are plastic materials formed by the polymerization of monomers, which are recognized as powerful sensitizers that may cause allergic contact dermatitis both in occupational and non-occupational environment. In the occupational setting, the most exposed workers are the dentists, dental technicians, prosthesis technicians, printers, painters, fiberglass workers and nail technicians. We describe four cases of occupational allergic contact dermatitis in nail technicians caused by acrylic compounds that illustrate numerous clinical manifestations. Clinical manifestations ranged from edema, erythema, scaling and fissuring fingertips to erythematous patches around the chin, mandible and abdomen. Patch testing results revealed positive reaction to 2-hydroxyethyl methacrylate in all patients. Of the four patients, two changed jobs, one stopped exposure because of pregnancy and one patient continued working, showing no improvement, despite undergoing treatment. These cases underline the importance of improvement of preventive measures in the workplace.
Sick building syndrome (SBS) is a complex syndrome consisting of non-specific symptoms with an onset associated with subjects’ presence in some modern building and the disappearance of symptoms shortly after they leave it. The effects of SBS may be the result of a series of protective reactions of the human body triggered by various types of surrounding environment, further suggesting that the human response could be based on a three-phase biological model: sensory perception, low degree inflammatory reactions and environmental stress reactions. Besides stress created by the discomfort of people who develop symptoms, SBS is the cause of an extensive loss of productivity, sickness absenteeism, wasted time in complaints with all the legal punitive issues that arise from them. The subjects diagnosed with SBS are hard to follow-up over time due to workers often leaving their jobs and being lost from cohort databases. Achieving a reputation of a “sick building” may prove difficult to rehabilitate even after expensive repairs and upgrades. In extreme cases closure and even demolition can occur. SBS is an evolving concept and this review we will present part of this evolution and what are the major challenges for its definition.
Occupational asthma, the most common occupational respiratory disease in industrialized societies, accounts for 5-10% of all cases of asthma diagnosed in the world. The number of cases is increasing given the development of the “consumer society”. We aim to discuss a case of occupational asthma that we have confirmed using internationally validated methods.