PMC1257604_01
In a process similar to that used by the patient, metalworking fluid (milky appearance) is flowed over auto parts to reduce friction and cool metal tools. As fluids are sprayed over metal parts, a visible aerosol is formed that can be breathed by operators of the machinery unless specific control measures are instituted. Fluids are recycled from large holding tanks. The presence of carbon and water in fluids permits growth of microorganisms, including mycobacteria.
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In his job he operated a machine that cut metal parts using a semi-synthetic metalworking fluid (Figure 1) that was collected and recycled through large tanks holding > 1,000 gal fluid.
Transbronchial biopsy specimen of the patient's lung showing marked alveolar inflammation and cell proliferation with the presence of inflammatory and epithelioid cells.
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A transbronchial lung biopsy (Figure 2) showed interstitial chronic inflammation and collections of epithelioid cells suggestive of granulomas with negative stains for acid-fast bacilli and fungus and, on review, diagnostic of hypersensitivity pneumonitis.
Thin-section CT scan of the chest showing ground glass opacities in the lung parenchyma, indicating interstitial inflammation and/or fibrosis.
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His pulmonologist repeated lung function tests, which showed a further decline in diffusing capacity to 44% predicted (Table 1), and a thin-section computed tomography (CT) scan of the chest (Figure 3) showed "ground glass" opacities indicating interstitial lung disease and mild bronchiectasis.