Case A 44-year-old man complained of a cough and dyspnea on exertion. Both symptoms had begun 7 years before his presentation, and have gradually progressed since that time. He noticed that the dyspnea develops with strenuous activity, fast walking, and is associated with chest tightness. He had a 27 pack-year history of tobacco but had recently quit after noticing the progressive symptoms. Job Profile Worked in mines with recycled copper and other metals for 3 years.
After developing the symptoms, his job duties included handling recycled metals, recovering slag in the smelter, and performing janitorial work including dry weeping. Medical History Two episodes of pneumonia He had participated in a whole lung lavage research protocol for silicosis. At the time of his lavage, the BAL cell differential revealed 63% lymphocytes. Examination Thin man, apparently with no respiratory distress…
