The Occupational/Environmental Health Clinic

Dept of Family Practice

MetroHealth Medical Center

2500 MetroHealth Drive

Cleveland, Ohio 44109-1998

(216)778-8087

Beryllium Patch Warning

The beryllium patch test should not be used because of false negatives, induction of beryllium sensitivity, and the possibility of severe anaphylactoid reaction.

Pathology

Pathologic changes in CBD include chronic interstitial pneumonitis with mononuclear cell infiltration and non-caseating granulomas. Non-caseating granulomas have also been found in the lymph nodes, liver, skin, spleen, and other tissues. Varying degrees of fibrosis may be present in different parts of the lung.

Other Tests

Active CBD is typically characterized by lymphocytosis in BAL fluid. Some patients may have one or more of the following: elevated serum IgG, elevated serum IgA, high erythrocyte sedimentation rate, erythrocytosis, hyperuricemia, hypercalcemia, or hypercalciuria.

Treatment

Patients with mild CBD may not need any treatment, but should be clinically followed with periodic assessment of symptoms, chest examination, pulmonary function tests, and chest x-rays. The only available treatment is corticosteroids. Improvements in symptoms, signs, clinical course, and radiographic abnormalities have been seen in some patients treated with corticosteroids. Patients presumptively diagnosed ashaving CBD without evidence of beryllium sensitization should be examined for possible systemic involvement by sarcoidosis (e.g., uveitis), since misdiagnosis of sarcoidosis as CBD is more likely in these individuals.

In severe CBD, as in any chronic lung disorder, hypoxemia, pulmonary hypertension, and right heart failure may require supportive measures including supplemental oxygen, diuretics, and possibly digitalis.