• Jing-hong Dai, Li-yun Miao, Yong-long Xiao, Fan-qing Meng, and Hou-rong Cai.
• Department of Pulmonary Medicine, Affiliated Drum Tower Hospital, Nanjing University School of Medicine, Nanjing 210008, China.
• Zhonghua Jie He He Hu Xi Za Zhi. 2009 Jul 1;32(7):493-6.

ObjectiveTo highlight the clinical, radiological and pathological characteristics of Objective To highlight the clinical, radiological and pathological characteristics of giant cell interstitial pneumonia (GIP) associated with Hard metals.MethodThe clinical, radiological and pathological data of a patient with hard metal lung disease confirmed by video-assisted thoracoscopic biopsy of the right lung were presented, and relevant literatures were reviewed.ResultsA 30-year-old female patient presented with cough and dyspnea on exertion for more than 40 days. She had worked for grinding tungsten rod, with exposure to metal dusts containing cobalt and tungsten for more than 3 years. Chest radiographs and CT demonstrated bilateral ground-glass attenuations and ill-defined small nodules. Lung function studies showed the mixed type of ventilation dysfunction with a low diffusion capacity (DLCO of 39% of predicted). Lung biopsy specimens showed desquamative interstitial pneumonia like reaction with alveolar macrophages and numerous large multinucleated histiocytes that ingested inflammatory cells in alveolar spaces, which was characteristics of GIP. The lung parenchyma also showed patchy chronic inflammatory-cell infiltrates centered predominantly around the bronchioles and interstitial fibrosis. Considering the exposure history and the histological findings of the lung, the diagnosis of hard metal lung disease and GIP associated with hard metals was made. Her cough, dyspnea, and radiological changes showed marked improvement after corticosteroid therapy and avoidance of further exposure to hard metals.ConclusionGIP is almost pathognomonic for hard metal lung disease. Meticulous history taking on occupational exposure is important for the diagnosis and differential diagnosis of suspected interstitial lung disease.

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