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Chronic Beryllium Disease

Beryllium is the lightest metal and has an atomic number 4. Gem stones, such as aquamarine, emerald, and beryl contain beryllium and have been recognized since ancient times. But beryllium, as an element, was first discovered in 1798 by the French chemist, Vauquelin and reduced to its metallic form; subsequently, it was named beryllium in 1828 by the German metallurgist, Wohler. Beryllium became a commercial product when it was used as an alloy first with aluminum and later with copper, nickel, and cobalt after World War I. The industry grew in the 1930s due to the increased use of beryllium–copper products during World War II and the use of beryllium oxide in the refractory and fluorescent lamp industries. During and after World War II, beryllium was used in the nuclear industry because of its ability to function as a neutron multiplier. Beryllium was used for both civilian nuclear reactors and for military weapons.

With an increased industrial need for beryllium, acute chemical pneumonitis was first described by Weber and Engelhardt1 in Germany in 1933 and in the United States by van Ordstrand et al. in 1943.2 This condition was usually limited to the upper respiratory tract, though it could extend to the bronchi, bronchioli, and alveoli if there was sufficient exposure. This condition peaked in the 1940s and will not only be seen if there are plant explosions or other serious lapses in procedures.3 The last reported possible case in the United States occurred in the early 1980s.

A second pulmonary complication of beryllium exposure was first described by Hardy and Tabershaw4 in 1946. This disease differed from the acute chemical pneumonitis because of the delayed onset, granulomatous response, and chronic course. Now known as chronic beryllium disease (CBD), this condition is a hypersensitivity reaction to beryllium and is the major hazard facing beryllium workers today.

Clinical Presentation

CBD is primarily a pulmonary granulomatous disorder. Although involvement of other organ systems has been reported (e.g., lymph node, skin, and liver), the lungs are the principal organ affected and account for the morbidity and mortality of this disease.5,6 In the early stages, CBD may be asymptomatic. A positive blood proliferative response to beryllium (evidence for beryllium hypersensitivity) may be the earliest sign of CBD.7,8 Radiologic changes can also be detected on routine chest radiographs. Symptomatic disease usually begins with nonspecific respiratory complaints, such as dyspnea and cough. Early in the disease process, routine chest radiography may not be helpful. Pulmonary function testing early in the disease may be normal or have an isolated abnormality of the diffusing capacity (DlCO).9 As the disease progresses, symptoms become more characteristic for chronic interstitial lung disease (ILD) with a nonproductive cough, substernal burning pain, and progressive exertional dyspnea. At this stage dry bibasilar crackles are observed ...

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