Berylliosis

Berylliosis is a systemic disease characterized mainly by inflammatory and granulomatous lesions in the lungs following inhalation of metallic beryllium dust, its alloys, or compounds. Exposure to beryllium is present in the aerospace, armaments, ceramics, electronics, nuclear, and machine industries; in the production of aluminum and copper alloys; in waste processing; and in prosthetic dentistry. The risk of developing berylliosis depends on the level and duration of exposure to beryllium dusts. Genetic susceptibility may play a role (HLA associations).

Clinical features: The clinical picture is very similar to that of pulmonary sarcoidosis, with dry cough and exertional limitation being the most common manifestations. Unlike in sarcoidosis, systemic signs and symptoms outside of cutaneous nodules (related to direct skin penetration) are rare.

A long latency period is characteristic. It lasts on average 5 to 15 years (1-30 years). The clinical course is variable, with some asymptomatic patients remaining stable over years, others experiencing relapses and remissions, and still others having progressive organ-threatening disease.

Diagnosis: Diagnosis is based on the finding of granulomatous lesions in the histologic examination of lung specimens and hypersensitivity to beryllium confirmed by a positive result of an in vitro beryllium lymphocyte proliferation test (BeLPT). Diagnostic procedures and differential diagnosis are the same as for sarcoidosis.

Treatment: The mainstay of therapy is lifelong avoidance of ongoing beryllium exposure. Standard medical treatment involves glucocorticoid therapy in patients who are symptomatic or with pronounced abnormalities on initial or follow-up investigations.