| A Retired Shipyard Worker with Rapidly Progressive Pulmonary Interstitial Fibrosis Eileen V. Moy,1 Howard Hu,1,2,3 and David C. Christiani1,2,4 1Occupational Health Program, Harvard School of Public Health, Center for Occupational and Environmental Medicine, Boston, MA 02115 USA
2Massachusetts Respiratory Hospital, South Braintree, MA 02184 USA
3Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115 USA
4Pulmonary and Critical Care Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115 USA Abstract
   Massachusetts Respiratory Hospital,
Harvard Medical School, and
Harvard School of Public Health We present a case of progressive interstitial fibrosis in a retired shipyard worker who was exposed to asbestos during the postwar era of the late 1940s and 1950s, when asbestos exposures in the workplace were not regulated. Forty years later, at 63 years of age, the patient presented with restrictive lung disease. The patient was diagnosed with asbestos-related pleural disease and parenchymal asbestosis. He remained stable for the next 7 years, but then he began to manifest rapid clinical progression, which raised the possibility of an unusual variant of asbestosis, a concomitant interstitial process, or an unrelated disease. Lung biopsy was not undertaken because of the patient's low pulmonary reserve and limited treatment options. An empiric trial of oral steroids was initiated, but his pulmonary status continued to deteriorate and he died of pulmonary failure at 72 years of age . Many diseases result in pulmonary interstitial fibrosis. Ideally, open lung biopsy should be performed, but this procedure inevitably causes complications in many patients with end-stage restrictive lung disease. Furthermore, while the presence of asbestos bodies in tissue sections is a sensitive and specific marker of asbestos exposure, neither this finding nor any other charge is a marker indicative of asbestosis or the severity of asbestosis. With the enactment of the Asbestos Standard in the United States, asbestos exposures have been decreasing in this country. However, industries that produce asbestos products and wastes continue to expand in developing countries. Prevention of asbestos-related lung disease should be a global endeavor, and asbestos exposures should be regulated in both developed and developing countries. Key words: asbestos, lung, pulmonary interstitial fibrosis. Environ Health Perspect 107:321-327 (1999) . [Online 17 March 1999] http://ehpnet1.niehs.nih.gov/docs/1999/107p321-327moy/ abstract.html Address correspondence to H. Hu, Channing Laboratory, Harvard Medical School, 181 Longwood Avenue, Boston, MA 02115 USA. This work was supported by NIEHS Center grant ES00002 and the American Cancer Society Physician's Training Grant in Preventive Medicine. Received 3 December 1998 ; accepted 10 December 1998.
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