Berylliosis Clinical Presentation

  • Author: Raed A Dweik, MD, FACP, FRCP(C), FCCP, FCCM, FAHA; Chief Editor: Zab Mosenifar, MD   more...
 
Updated: May 26, 2011
 

History

The most significant exposure to beryllium occurs in the occupational setting. Obtaining a good occupational history is critical to effective diagnosis.

Occupations with the highest potential for exposure to beryllium are those involved with primary production, metal machining, and reclaiming scrap alloys. Other high-exposure occupations are in the nuclear power, aerospace, and electronics industries. Some of the modern day uses of beryllium include the following:

  • Nuclear reactors and weapons
  • Inertial guidance systems
  • X-ray tube windows
  • Turbine rotor blades
  • Spark plugs
  • Laser tubes
  • Electrical components
  • Rocket engine liners
  • Ceramic applications
  • Springs, gears, aircraft brakes, aircraft engines, landing gear, and bearings
  • Oil and gas industries
  • Injection and blow mold tooling
  • Welding electrodes
  • Electrical contacts
  • Computer electronics
  • Automotive electronics

The number of industries that use beryllium is continuously expanding and the above list should not be viewed as exclusive. Beryllium has been used in a wide variety of products, including some bicycles and golf clubs.

Individuals using end products that contain beryllium, however, are not currently considered at risk for sensitization or disease. Only if the beryllium component is handled in a way that generates beryllium dust or particles (eg, sanding) would there be a risk.

With the use of the BeLPT, establishing the diagnosis of CBD before any symptoms develop now is common.

Dyspnea, usually of insidious onset, is the most common symptom. Other symptoms include the following:

  • Cough
  • Chest pain
  • Arthralgia
  • Fatigue
  • Weight loss
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Physical

Making the diagnosis of CBD before any physical signs can be detected now is common. Physical signs include the following:

  • Inspiratory crackles on pulmonary auscultation
  • Lymphadenopathy
  • Rash (dermatitis)[3]
  • Hepatosplenomegaly
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Causes

Chronic beryllium disease (CBD), or berylliosis, is an occupationally acquired lung disease caused by exposure to beryllium, primarily by inhalation and contact through broken skin.

Genetic predisposition seems to have a major role in the development of CBD. A variant of the major histocompatibility complex HLA-DPb1(Glu 69) was found in 97% of patients with CBD and only in 30% of controls. In this genetic variant, glutamine is expressed instead of lysine at position 69 of the beta region of class II of the major histocompatibility complex.[4] This genotype is a marker for susceptibility to CBD, but it is not useful as a screening test due to its high prevalence in the general population (>30%).

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Contributor Information and Disclosures
Author

Raed A Dweik, MD, FACP, FRCP(C), FCCP, FCCM, FAHA,  Associate Professor of Medicine, Cleveland Clinic Lerner College of Medicine; Director, Pulmonary Vascular Program, Respiratory Institute, Cleveland Clinic

Raed A Dweik, MD, FACP, FRCP(C), FCCP, FCCM, FAHA, is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Heart Association, American Medical Association, American Thoracic Society, Royal College of Physicians and Surgeons of Canada, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Oleh Wasyl Hnatiuk, MD  Program Director, National Capital Consortium, Pulmonary and Critical Care, Walter Reed Army Medical Center; Associate Professor, Department of Medicine, Uniformed Services University of Health Sciences

Oleh Wasyl Hnatiuk, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and American Thoracic Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Gregg T Anders, DO  Medical Director, Great Plains Regional Medical Command , Brooke Army Medical Center; Clinical Associate Professor, Department of Internal Medicine, Division of Pulmonary Disease, University of Texas Health Science Center at San Antonio

Gregg T Anders, DO is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and American Thoracic Society

Disclosure: Nothing to disclose.

Timothy D Rice, MD  Associate Professor, Departments of Internal Medicine and Pediatrics and Adolescent Medicine, St Louis University School of Medicine

Timothy D Rice, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Physicians

Disclosure: Nothing to disclose.

Chief Editor

Zab Mosenifar, MD  Director, Division of Pulmonary and Critical Care Medicine, Director, Women's Guild Pulmonary Disease Institute, Professor and Executive Vice Chair, Department of Medicine, Cedars Sinai Medical Center, University of California, Los Angeles, David Geffen School of Medicine

Zab Mosenifar, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, and American Thoracic Society

Disclosure: Nothing to disclose.

References

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  2. Van Dyke MV, Martyny JW, Mroz MM, et al. Risk of Chronic Beryllium Disease by HLA-DPB1 E69 Genotype and Beryllium Exposure in Nuclear Workers. Am J Respir Crit Care Med. Mar 11 2011;[Medline].

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  10. Amicosante M, Berretta F, Franchi A, Rogliani P, Dotti C, Losi M, et al. HLA-DP-unrestricted TNF-alpha release in beryllium-stimulated peripheral blood mononuclear cells. Eur Respir J. Nov 2002;20(5):1174-8. [Medline].

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A high-resolution CT scan of the chest showing the typical ground glass appearance in a patient with chronic beryllium disease, or berylliosis.
A histopathology slide (hematosin and eosin stain) showing the typical well-formed granuloma of chronic beryllium disease, or berylliosis.
 
 
 
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