Case Report
Systemic Iron Overload Associated with Welder’s Siderosis

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Abstract

Welding involves exposure to fumes, gases, radiation, electricity, noise, and heat. Herein, we describe 2 welders presenting with lung infiltrates and elevated liver enzyme levels. Both of these patients had pulmonary siderosis (“welder’s lung”) on lung biopsy along with evidence of systemic iron overload. Evaluation for genetic hemochromatosis and other known causes of iron overload was unrevealing. Welding with chronic inhalation of iron particles maybe an under-recognized source of systemic iron overload.

Section snippets

CASE 1

A 40-year-old man presented with persistent fatigue and intermittent chest pains. He was a smoker who had been averaging 1 ½ packs of cigarettes per day for over 25 years. Twenty-one months before, he was admitted to another hospital with bilateral pleuritic chest pain. His inpatient evaluation included a computed tomographic (CT) scan of the chest that revealed bilateral pulmonary infiltrates characterized by poorly defined centrilobular micronodules without associated intrathoracic

CASE 2

A 52-year-old man presented for evaluation of bilateral lung infiltrates noted incidentally during a preoperative evaluation for hand surgery (debridement of a finger infection). He had been a welder for 23 years. He denied any respiratory symptoms including cough, shortness of breath, expectoration, fever, chills, and weight loss. He was a smoker with a 68 pack-years smoking history. There was no history of hematologic disorders or transfusions. His physical examination was notable for

DISCUSSION

Welder’s pneumoconiosis was first described in 1936 by Doig and McLaughlin6 and in most cases represents pulmonary siderosis caused by chronic inhalation of welding fumes.1., 2., 3., 4., 5. The chief component of fumes resulting from most welding processes is iron oxide. Pulmonary siderosis results from deposition of iron in the lung which is partly ingested by alveolar macrophages. It is generally considered a benign condition.1., 2., 3.

Although the association of welding and pulmonary

CONCLUSION

Both of our patients had CT findings and histopathologic features documented by lung biopsy of welder’s siderosis that was associated with evidence for systemic iron overload. There was no evidence of genetic hemochromatosis or other identifiable cause for iron overload aside from chronic welding exposure. We conclude that welder’s lung (siderosis) can be associated systemic iron overload from chronic inhalation of iron particles. Welding maybe an under-recognized source of systemic iron

REFERENCES (12)

  • AntoniniJ.M.

    Health effect of welding

    Crit Rev Toxicol

    (2003)
  • AntoniniJ.M. et al.

    Pulmonary responses to welding fumes: role of metal constituents

    J Toxicol Environ Health Part A

    (2003)
  • AntoniniJ.M. et al.

    Pulmonary effects of welding fumes: review of worker and experimental animal studies

    Am J Indust Med

    (2003)
  • SferlazzaS.J. et al.

    The respiratory health of welders

    Am Rev Respir Dis

    (1991)
  • NemeryB.

    Metal toxicity and the respiratory tract

    Eur Respir J

    (1990)
  • DoigA.T. et al.

    X-ray appearance of the lungs of electric welders

    Lancet

    (1936)
There are more references available in the full text version of this article.

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