Chest
Volume 108, Issue 5, November 1995, Pages 1196-1200
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Clinical Investigations: Cardiology
Desquamative Interstitial Pneumonitis and Diffuse Alveolar Damage in Textile Workers: Potential Role of Mycotoxins

https://doi.org/10.1378/chest.108.5.1196Get rights and content

Five of 88 workers at a textile plant developed interstitial lung disease. Biopsy specimens from the three initial cases demonstrated desquamative interstitial pneumonitis and diffuse alveolar damage. Two of these patients developed hypoxemic respiratory failure despite high-dose corticosteroid therapy. A survey of the remaining textile workers (questionnaires, chest radiographs, and pulmonary function tests) revealed one new case. This patient, and one other with a compatible presentation, improved clinically upon leaving the workplace and did not require therapy. A comprehensive assessment of the work environment was performed in search of potentially toxic respirable agents. We propose that these cases represent desquamative interstitial pneumonitis-like reactions, occupationally related to aflatoxin inhalation.

Section snippets

Case Series

Five male textile workers, aged 26 to 53 years, presented between April 1990 and November 1991 with breathlessness and cough (Table 1). Two patients had mild constitutional symptoms. The duration of symptoms prior to presentation ranged from 3 months to 5 years. All patients suffered acute exacerbations 5 to 7 days prior to their presentation. Severity of symptoms appeared to relate to duration of symptoms and duration of employment (range, 18 months to 8 years).

On examination, all patients

Discussion

The existence of DIP, as described by Liebow,1,2 as a distinct clinical entity has been debated for many years.3, 4, 5, 6, 7, 8 In most cases, there is no known cause, and DIP is still considered a subtype of idiopathic pulmonary fibrosis. This categorization remains useful clinically in predicting response to therapy and prognosis.3,8,9 More recently, “DIP-like” reactions have been described, which may be diffuse or focal (Table 2).6, 7, 8,10 This term is used when the pathologic features of

Acknowledgments

The writers thank Dr. Meri Bukowskyj, Respirology and Internal Medicine, Kingston, Canada, for generously sharing data with us; Dr. Alan Fletcher, Department of Pathology, Kingston (Canada) General Hospital, for his assistance in the interpretation of the pathologic findings of these cases; and Dr. Lewis Tomalty of the Department of Microbiology, Kingston General Hospital, and Dr. David Miller of the Plant Research Center, Ottawa (Canada) Experimental Farm, for their assistance in performing

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Presented in part at the Royal College of Physicians and Surgeons of Canada Annual Meeting, September 11–14, 1992, Ottowa. Manuscript received August 24, 1994; revision accepted June 9, 1995.

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