Hard metal lung disease (HMLD) is a
pneumoconiosis caused by occupational exposure to hard metals such as
tungsten carbide and
cobalt, but the treatment strategies for HMLD have not been well established. A 68-year-old Japanese man with occupational history as a grinder of hard metals for 18 years referred to our hospital because of dry
cough and
dyspnea. A chest computed tomography (CT) on admission revealed centrilobular micronodules, ground-glass opacities, and reticular opacities in the peripheral zone of both lungs. Mineralogic analyses of lung tissues detected components of hard metals, such as
tungsten,
titanium and
iron, and the same metals were also detected in the sample of the dust of his workplace. Thus, the patient was diagnosed as having HMLD based on occupational exposure history and radiologic and mineralogic analyses of the lung.
Corticosteroid therapy was initiated, which resulted in partial improvements in his symptoms, radiological and pulmonary functional findings. In a review of the 18 case reports of HMLD treated with
corticosteroids, including our case, the majority of patients (77.8%) showed favorable responses to
corticosteroid treatment. Furthermore, the presence of fibrotic changes, such as reticular opacity, in radiological examinations was associated with the resistance to
corticosteroids. In conclusion, the majority of patients with HMLD are expected to favorable response to
corticosteroid treatment, whereas chest CT findings such as fibrotic changes may be predictive of the resistance of
corticosteroid treatment. Lastly, proper prevention of
hard metal exposure is most important as the first step.