Gardiner, I T, and Uff, J S (1978). Thorax, 33,[806][807][808][809][810][811][812][813]. "Blue bodies" in a case of cryptogenic fibrosing alveolitis (desquamative type)-an ultra-structural study. A patient with cryptogenic fibrosing alveolitis, with both mural and desquamative features, had two lung biopsies at the times of coronary artery surgery. These lung specimens were studied, using light and electron microscopy, with immunofluorescence techniques and electron microanalysis. In addition to the typical changes of cryptogenic fibrosing alveolitis previously reported, we found "blue-staining bodies" within alveolar macrophages and giant cells. These bodies were 15-25 ,um in diameter with an iron rich outer rim and core of connective tissue mucin-possibly chondroitin sulphate or dermatan sulphate. It seems unlikely that these "blue bodies" were due to fibreglass dust to which the patient had had a trivial exposure, but their exact nature and significance remains unclear.Since Liebow et al (1965) first described desquamative interstitial pneumonitis, there have been several studies reporting the ultra-structural characteristics of both biopsy and necropsy specimens (Brewer et a!, 1969;Shortland et al, 1969;Farr et al, 1970;Patchefsky et al, 1971). While these authors have described in detail many features of the intra-alveolar cells, including intranuclear inclusion bodies, there have been no previous reports of intracytoplasmic inclusion bodies ("blue bodies").
Case historyA 55-year-old man was referred to hospital in 1974 for coronary artery surgery. He had a sixmonth history of exertional dyspnoea but no cough or sputum, despite having smoked 15 cigarettes a day for 35 years. He had worked as a bus driver for most of his life, turning to clerical work only when disabled by angina. As a clerk he had trivial and infrequent exposure to fibreglass and resin dust. For about 20 minutes each working day over a three-year-period he walked through workshops where mock-ups of aircraft components were being manufactured from fibreglass. The atmosphere in these rooms was not obviously dusty, and extractor fans were in constant use. The materials used were epoxy resin, polyester resin, and amine hardeners.Inquiry at the plant did not show any respiratory effects from these materials in other workers. The patient had no exposure to fungi or pet birds; avian and fungal precipitins and rheumatoid factor were not found in the patient's serum. His chest radiograph had previously been regarded as normal, but a review of his films since 1970 showed a fine granular appearance in the lower zones. This appearance has remained unchanged. Because of some suspicion of lung abnormality, a wedge biopsy of the right upper lobe was performed at the time of his first coronary artery graft early in 1974. On the results of this biopsy, he was given an eight-week course of prednisolone without objective improvement in his condition. This treatment was curtailed by the need for further coronary artery surgery, which was unsuccessful, and a th...