Abstract
INTRODUCTION: Occupational exposure to chemical products are a direct cause of respiratory diseases but might also induce autoimmunity with possible secondary pulmonary involvement.OBJECTIVE: Describe the possible link between volatile chemical exposure and development of autoimmune disease with lung involvement.METHODS: We report three cases from our occupational disease center who developed autoimmunity and lung disease after chemical exposure.RESULTS: Case 1: 32 year-old man with fever, dyspnea, arthritis, Gottron papules and proximal muscle weakness. He worked coating pipes with polyurethane and manipulated volatile hydrocarbonates for five years. HRCT revealed parenchymal bands, autoantibody tests showed positive antinuclear factor (nuclear pattern 1/160) and electromyography suggested myositis. Case 2: 47 year-old woman with dyspnea, arthritis and proximal weakness after acute inhalation of gases and mist liberated from mixing sodium hypochlorite with ethanol. HRCT showed ground-glass and irregular reticular opacities, the pulmonary function test showed a restrictive pattern and the rheumatoid factor was positive. Case 3: 31 year-old man with mild dry cough who worked with polyvinyl chloride resin, methylethylketone, dimethylformamide and turpentine for the last two years. HRCT showed ground glass and traction bronchiectasis; lung biopsy showed interstitial fibrosis, giant cells, traction bronchiolectasis and honeycombing.CONCLUSION: Chemical exposures can be associated with direct pulmonary damage, but occupational exposure to these inhalants seems to damage alveolar cells in a form that this inflammatory stimulus would trigger systemic autoimmunity with possible secondary lung involvement.