Berylliosis Clinical Presentation

Updated: Dec 31, 2015
  • Author: Raed A Dweik, MD, MBA, FACP, FRCPC, FCCP, FCCM, FAHA; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Presentation

History

The most significant exposure to beryllium occurs in the occupational setting. Obtaining a good occupational history is critical to effective diagnosis. [3]

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) [4]

  • 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. [5] 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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