In April 1992 an outbreak of severe respiratory illness occurred among aerographic textile workers in the area of Alcoi, Autonomous Community of Valencia, Spain. An epidemiological study linked this outbreak to the use of a reformulated aerosolized product,
Acramin-FWN. We analyzed clinical, laboratory, and pathological data of the first 14 patients with confirmed
organizing pneumonia (OP) secondary to this newly recognized occupational toxicant. The mean age of the patients was 30 yrs. The most common clinical findings were
cough (86%),
epistaxis (71%), dyspnoea (64%), oppressive
chest pain (57%), and
crackles (50%). A restrictive functional pattern was evident in 64%. Radiographic findings consisted predominantly of patchy infiltrates in 65% and a micronodular pattern in 35%. Treatment with
corticosteroids did not prevent initial progression in 11 of the 14 patients and development of irreversible
respiratory failure in five patients. At necropsy, besides features of OP, interstitial
fibrosis and diffuse alveolar damage were evident. A low total lung capacity, the presence of
crackles at admission, and increases in the alveolar-arterial
oxygen difference were predictive of death. The
organizing pneumonia caused by the inhalation of
Acramin-FWN is characterized by a tendency to evolve into progressive interstitial
fibrosis despite the use of
corticosteroids. The illness is restricted to the respiratory system and once
respiratory failure has developed the prognosis is poor.