SHM Converge Scientific Abstract ePoster Gallery-Forged in Dust: The Silent Threat of Tungsten Carbide Lung Disease

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This case describes a 64-year-old man with progressive exertional dyspnea and dry cough over 9 months after 18 years of work in a tungsten carbide grinding room. He had no smoking history or other notable inhalational exposures. On exam, he had diminished breath sounds and inspiratory crackles. Pulmonary function testing showed a restrictive pattern with severely reduced diffusing capacity. Autoimmune testing was negative. Lung wedge biopsy revealed fibrosing bronchiolocentric interstitial pneumonia with giant cells and leukoerythrophagocytosis, supporting hard metal lung disease (HMLD).<br /><br />HMLD is a rare occupational lung disorder caused by exposure to hard metal particles, especially tungsten carbide and cobalt. The discussion notes that macrophage uptake of tungsten may contribute to fibrosis, and combined WC-Co exposure appears more harmful than either component alone. Hard metal manufacturing has also been associated with increased lung cancer mortality.<br /><br />The patient was advised to stop further tungsten carbide exposure and received several short courses of inhaled and oral steroids over the following year. His clinical course improved steadily, with better exercise tolerance and recovery of lung function over time. Imaging and pulmonary function findings also normalized or improved substantially over years of follow-up.<br /><br />The report highlights that HMLD should be considered in workers exposed to hard metals who develop unexplained interstitial lung disease. While treatment evidence remains limited, corticosteroids may help in some cases, and antifibrotic agents such as nintedanib may be beneficial, though data for pirfenidone are less certain.

Asset Subtitle

Asma Mohammadi

Meta Tag

Author List Asma Mohammadi

Category Clinical Vignettes

Concept Hard Metal Lung Disease

Concept Progressive Exertional Dyspnea

Concept Fibrosing Bronchiolocentric Interstitial Pneumonia

Concept Removal from Exposure

Concept Occupational Interstitial Lung Disease

Distinguished Non-Finalist

Presenter Organization Upmc

Presenting Author Asma Mohammadi

Track Adult

Keywords

hard metal lung disease

tungsten carbide

occupational lung disease

interstitial lung disease

cobalt exposure

fibrosing bronchiolocentric pneumonia

restrictive lung disease

diffusing capacity

corticosteroid treatment

lung fibrosis

Hard Metal Lung Disease

Progressive Exertional Dyspnea

Fibrosing Bronchiolocentric Interstitial Pneumonia

Removal from Exposure

Occupational Interstitial Lung Disease