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Haemorrhagic hypersensitivity pneumonitis due to naphthylene-1,5-diisocyanate

¹ Research Institute for Occupational Medicine (BGFA), Bochum, ² Institute of Pathology, Saarland-University, Homburg/Saar, ³ Schwerin Hospital, Medical Dept, Schwerin, ⁴ Institute for Occupational Medicine, University of Hamburg, Germany

CORRESPONDENCE: R. Merget, Research Institute for Occupational Medicine, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany. Fax: 49 2343074505. E-mail: merget@bgfa.de

Keywords: hypersensitivity, immunologic haemorrhagic pneumonia, isocyanates, naphthylene-1,5-diisocyanate, pneumonitis

Received: May 11, 2001
Accepted August 2, 2001

Abstract

Symptoms of hypersensitivity pneumonitis and massive pulmonary haemorrhage occurred in a 24-yr-old male shortly after occupational exposure to naphthylene-1,5-diisocyanate (NDI).

The present examination was performed 1-yr after the initial life-threatening haemoptysis and following an uneventful recovery after resection of the middle lobe, which had been identified bronchoscopically as the bleeding source. Histological re-examination of the lung was compatible with hypersensitivity pneumonitis.

After a chamber challenge with NDI (5 parts per billion (ppb) for 10 min, 10 ppb for 110 min), rales were heard in both lungs, and a fall in vital capacity and partial pressure of arterial oxygen as well as a rise in body temperature were documented. Isocyanate-specific immunoglobulin-G antibodies could not be detected in the patient's serum, possibly due to the long period without exposure to isocyanates.

The authors conclude that naphthylene-1,5-diisocyanate may cause immunological pulmonary haemorrhage. The underlying disease is consistent with hypersensitivity pneumonitis and may be triggered by low concentrations of the diisocyanate.