TY - JOUR T1 - A case of welder's lung with a differential diagnosis of hypersensitivity pneumonitis JF - European Respiratory Journal JO - Eur Respir J VL - 44 IS - Suppl 58 SP - P4146 AU - Ayse Baccioglu AU - Fusun Kalpaklioglu AU - Onder Bozdogan AU - Mikail Inal AU - Omur Gungor Y1 - 2014/09/01 UR - http://erj.ersjournals.com/content/44/Suppl_58/P4146.abstract N2 - Welder's lung is a rare occupational disease which is usually seen after chronic exposure to iron dust. This is a case with 2 exposures to cause lung disease as welding and pigeon feeder. A 43-year-old man with a dyspnoea, and cough was a welder for 20years, and had pigeons for 30 years. He had a predicted FEV1 of 94%, predicted FEV1/FVC of 73%, diffusion lung capacity of 80%. He had mild hypoxemia (pO2=63mmHg). His chest radiograph showed a pattern of reticular-nodular opacities with equally dominant in all zones. High-resolution computed tomography (CT) showed bilateral, generalized, multiple centre-asiner micronodular opacities. A prediagnose of hypersensitivity pneumonitis was proposed with 3 major criteria (symptoms, radiology, exposure to pigeons) and minor criteria of hypoxemia. However, it was ruled out with continuing lung symptoms though avoidance from pigeons, no increase in symptoms nearby pigeons, and no lymphocytic/neutrophilic alveolitis in bronchial lavage, corticosteroid insensitivity in the event of no pulmonary fibrosis, no decrease in pulmonary function tests and diffusion lung capacity, and no crackles. A diagnosis of welder's lung disease was done with occupational environment as iron dust particles, compatible chest CT pattern, and positive staining for ferritin (Prussian blue stain) in macrophages and outside cells of bronchial lavage fluid. His hypoxemia was improved even after partial bronchial washing. As a treatment, he was recommended to quit his job as well as smoking, and avoidance form pigeons since their exposure together might have a potential power to develop lung fibrosis, lung cancer, fungus ball, or asthma. ER -