Abstract Introduction Galvanized steel is coated with zinc which, when heated during processes such as welding, can release zinc-oxide (ZnO) particles into the air. ZnO exposure may lead to a myriad of pulmonary symptoms. We present an atypical case of a young man exposed to ZnO in his workplace who subsequently developed severe, chronic respiratory symptoms and multiple laboratory abnormalities. Description of Case Mr. C is a 32 year-old male with a history of mild asthma who presented to the pulmonary clinic with one year of severe shortness of breath, pleuritic chest pain, and exercise intolerance without wheezing or cough. His symptoms began abruptly while welding galvanized steel without a respirator. His symptoms were initially attributed to an asthma flare, and he was treated with five days of 20 mg oral prednisone. After treatment, his symptoms remained stable, but significantly limited his ability to exercise and work. Pulmonary function tests (PFTs) were performed, which showed evidence of severe restriction without airflow limitation. Due to significant abnormalities in his PFTs, he was referred to our institution’s pulmonary clinic and medical toxicology clinic for further evaluation. His exam was notable for an inability to inspire or exhale deeply due to severe, burning, pleuritic pain. A high-resolution CT scan was performed, which was largely unremarkable. He was found to have an IgE level of 1123 kU/L and serum eosinophil level of 4.0 K/mcL. This prompted a further investigation into hypereosinophilic etiologies which included a positive Aspergillus-IgE but negative Aspergillus-IgG, ANCA, ANA, FISH panel, tryptase, and parasitic testing. He is now being trialed on high-dose prednisone (1mg/kg) with a prolonged taper over 3 months. Discussion Zinc-oxide exposure can lead to Metal Fume Fever (MFF), which typically presents as nonspecific flu-like symptoms with shortness of breath, cough, and chest pain. It may present immediately or with subsequent exposures. Symptoms typically resolve after discontinuation of welding activity, however in some cases patients may have an exacerbation of underlying pulmonary conditions which requires further treatment. ZnO has been linked to peripheral eosinophilia and elevated IgE levels through multiple proposed mechanisms. Our patient’s case may represent an atypical presentation of MFF with unique features such as the patient’s symptom manifestations, time course, and elevated Aspergillus-specific IgE. Occupational exposure to materials such as galvanized steel should be considered in the differential diagnosis for patients with hypereosinophilia or severely elevated IgE levels. This abstract is funded by: None
Shepherd et al. (Fri,) studied this question.