Source: Annual Congress 2002 - Exposure to chemicals
Disease area: Interstitial lung diseases, Respiratory infections

Abstract

Bronchiolitis Obliterans Organizing Pneumonia (BOOP) is an inflammatory lung disease either idiopathic or associated with tumors, radiotherapy, organ transplantation, collagen diseases, haematologic malignancies, immunodeficiency syndromes, drug hypersensitivity reactions, and other rare diseases. Rarely BOOP is reported as environment related due to occupational agents exposure.
A previously healthy 46 years old cleaning lady was hospitalized for severe dyspnea, cough and fever occurred few weeks after a spill of a cleaning agent containing ammonium chloride compounds. Chest radiograph and CT scan showed a massive right lower lobe alveolar infiltrate with multicavitary lesions. ESR was 44 mm/h and the cytometer used for the CBC count indicated a suspected myeloperoxidase deficiency, confirmed by a cytochemical study of blood smears. Sputum examination and colture for microorganisms including acid fast bacilli, Candida and other moulds were repeatedly negative. Antinuclear antibodies and anti neutrophil cytoplasmic antibodies were negative. Transbronchial biopsy showed myxoid fibroblastic tissue and intrabronchiolar aggregates of mononuclear cells invading alveolar spaces, consistent with BOOP. Prednisone (50 mg/d) was started with prompt resolution of symptoms and minimal residual infiltrates. No relapses were observed after the slow tapering of steroids.
In the reported case exposure to ammonium chloride compounds has a clear causative role in the pathogenesis of this environment related BOOP and its presentation with cavitary infiltrates is a rare radiologic pattern. The defect in the formation of neutrophil granules due to myeloperoxidase deficiency should be furtherly studied in the development of this type of BOOP.

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F. Di Stefano, N. Verna, S. Siriruttanapruk, R. Paganelli, F. Paolini, M. Di Gioacchino (Chieti, Italy). Cavitating bronchiolitis obliterans organizing pneumonia (BOOP) associated with myeloperoxidase deficiency in a floor cleaner exposed to ammonium chloride compounds. Eur Respir J 2002; 20: Suppl. 38, 862

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