Unique case of interstitial lung disease in a dental toolmaker

A 50-year-old man with no prior medical history presented with progressive dyspnea and cough. This is a case of interstitial lung disease (ILD) due to an unusual exposure. The patient soldered and welded dental devices for twelve years, during which he lacked adequate respiratory protection. The shortness of breath and a non-productive cough progressed even after being treated with antibiotics. Pulmonary function tests (PFTs) revealed a restrictive pattern, and the computed tomography (CT) scan displayed reticulonodular opacities mixed with ground glass opacities concentrated at the bases. A lung biopsy suggested usual interstitial pneumonitis (UIP); however, nonspecific interstitial pneumonitis (NSIP) was also suggested. Although some hypersensitivity features were present on histology, other features prevent a definite diagnosis of hypersensitivity pneumonitis (HP). This case highlights the unique occupational exposure for ILD and the challenges with formulating the diagnosis.