Sarcoidosis and Chronic Beryllium Disease: Similarities and Differences

Abstract

Chronic beryllium disease (CBD) is a granulomatous lung disease that may be pathologically and clinically indistinguishable from pulmonary sarcoidosis, except through use of immunologic testing, such as the beryllium lymphocyte proliferation test (BeLPT). Similar to sarcoidosis, the pulmonary manifestations of CBD are variable and overlap with other respiratory diseases. Definitive diagnosis of CBD is established by evidence of immune sensitization to beryllium and diagnostic bronchoscopy with bronchoalveolar lavage and transbronchial biopsy. However, the diagnosis of CBD can also be established on a medically probable basis in beryllium-exposed patients with consistent radiographic imaging and clinical course. Beryllium workers exposed too much higher levels of beryllium in the past demonstrated a much more fulminant disease than is usually seen today. Some extrapulmonary manifestations similar to sarcoidosis were noted in these historic cohorts, although with a narrower spectrum. Extrapulmonary manifestations of CBD are rare today. Since lung-predominant sarcoidosis can very closely resemble CBD, CBD is still misdiagnosed as sarcoidosis when current or past exposure to beryllium is not recognized and no BeLPT is obtained. This article describes the similarities and differences between CBD and sarcoidosis, including clinical and diagnostic features that can help physicians consider CBD in patients with apparent lung-predominant sarcoidosis.

Hypersensitivity Pneumonitis A Perspective From Members of the Pulmonary Pathology Society

“…Berylliosis occurs from inhalation exposure to beryllium metal or salts. Exposure is typically occupationally related (computer manufacturing or aerospace engineering) [41][42][43] ; however, there are reports in the medical literature of berylliosis developing in those living near facilities using beryllium. 44 Ill-defined granulomas and giant cells are also described in LIP, which is a form of lymphoid hyperplasia.…”

Differenzialdiagnose bei mediastinaler und hilärer Lymphadenopathie mit Fokus auf berufsbedingte Krankheitsbilder

“…Die Berufskrankheit Berylliose wird durch die inhalative Berylliumstaub-Exposition hervorgerufen, wie sie in bestimmten industriellen Fertigungsprozessen, z. B. in der Elektronik-, Militär-und Automobiltechnik sowie bei Verunreinigungen durch Beryllium in der Metallverarbeitung auftritt [15,16]. Dabei kommt es unter disponierten Personen zu einer zellvermittelten spezifischen Sensibilisierung [3].…”

“…Dabei kommt es unter disponierten Personen zu einer zellvermittelten spezifischen Sensibilisierung [3]. Ein Teil der Sensibilisierten entwickelt Krankheitssymptome [16]. Sehr selten ist die akute Berylliose zu beobachten, die mit trockenem Husten und progressiver Belastungsdyspnoe, Konjunktivitis, Dermatitis, Pharyngitis, Laryngotracheobronchitis und chemischer Pneumonitis einhergeht [16].…”

“…Ein Teil der Sensibilisierten entwickelt Krankheitssymptome [16]. Sehr selten ist die akute Berylliose zu beobachten, die mit trockenem Husten und progressiver Belastungsdyspnoe, Konjunktivitis, Dermatitis, Pharyngitis, Laryngotracheobronchitis und chemischer Pneumonitis einhergeht [16]. Im Vordergrund steht die chronische Berylliose.…”

To progress understanding of disease triggers and modifiers in sarcoidosis, stratification is the key

“…Chronic beryllium disease is a granulomatous lung disease caused by exposition to beryllium. The disease is clinically indistinguishable from pulmonary sarcoidosis and nowadays extrapulmonary manifestations are regarded rare [16]. Carriership of human leukocyte antigen (HLA)-DPB1 E69 contributes significantly to the risk of disease with odds ratios for E69 homozygotes versus non-carriers of over 20 [17].…”