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Semin Respir Crit Care Med 2014; 35(03): 316-329
DOI: 10.1055/s-0034-1377059
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Sarcoidosis and Chronic Beryllium Disease: Similarities and Differences

Annyce S. Mayer
1   Division of Environmental and Occupational Health Sciences, Department of Medicine, National Jewish Health, Denver, Colorado
2   Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, Colorado School of Public Health, Aurora, Colorado
,
Nabeel Hamzeh
1   Division of Environmental and Occupational Health Sciences, Department of Medicine, National Jewish Health, Denver, Colorado
3   School of Medicine, University of Colorado, Aurora, Colorado
,
Lisa A. Maier
1   Division of Environmental and Occupational Health Sciences, Department of Medicine, National Jewish Health, Denver, Colorado
2   Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, Colorado School of Public Health, Aurora, Colorado
3   School of Medicine, University of Colorado, Aurora, Colorado
› Author Affiliations
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Publication History

Publication Date:
09 July 2014 (online)

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Abstract

Chronic beryllium disease (CBD) is a granulomatous lung disease that may be pathologically and clinically indistinguishable from pulmonary sarcoidosis, except through use of immunologic testing, such as the beryllium lymphocyte proliferation test (BeLPT). Similar to sarcoidosis, the pulmonary manifestations of CBD are variable and overlap with other respiratory diseases. Definitive diagnosis of CBD is established by evidence of immune sensitization to beryllium and diagnostic bronchoscopy with bronchoalveolar lavage and transbronchial biopsy. However, the diagnosis of CBD can also be established on a medically probable basis in beryllium-exposed patients with consistent radiographic imaging and clinical course. Beryllium workers exposed too much higher levels of beryllium in the past demonstrated a much more fulminant disease than is usually seen today. Some extrapulmonary manifestations similar to sarcoidosis were noted in these historic cohorts, although with a narrower spectrum. Extrapulmonary manifestations of CBD are rare today. Since lung-predominant sarcoidosis can very closely resemble CBD, CBD is still misdiagnosed as sarcoidosis when current or past exposure to beryllium is not recognized and no BeLPT is obtained. This article describes the similarities and differences between CBD and sarcoidosis, including clinical and diagnostic features that can help physicians consider CBD in patients with apparent lung-predominant sarcoidosis.

Keywords

chronic beryllium disease - sarcoidosis - berylliosis - beryllium - lymphocyte proliferation test - granuloma - occupational disease
 

  • References

  • 1 Saltini C, Winestock K, Kirby M, Pinkston P, Crystal RG. Maintenance of alveolitis in patients with chronic beryllium disease by beryllium-specific helper T cells. N Engl J Med 1989; 320 (17) 1103-1109
    CrossrefPubMedGoogle Scholar
  • 2 Freiman DG. Pathologic changes of beryllium disease; discussion of papers by Drs. Hazard and Dudley. AMA Arch Ind Health 1959; 19 (2) 188-189
    PubMedGoogle Scholar
  • 3 Statement on sarcoidosis. Joint Statement of the American Thoracic Society (ATS), the European Respiratory Society (ERS) and the World Association of Sarcoidosis and Other Granulomatous Disorders (WASOG) adopted by the ATS Board of Directors and by the ERS Executive Committee, February 1999. Am J Respir Crit Care Med 1999; 160 (2) 736-755
    CrossrefPubMedGoogle Scholar
  • 4 Thomas PD, Hunninghake GW. Current concepts of the pathogenesis of sarcoidosis. Am Rev Respir Dis 1987; 135 (3) 747-760
    PubMedGoogle Scholar
  • 5 Hunninghake GW, Crystal RG. Pulmonary sarcoidosis: a disorder mediated by excess helper T-lymphocyte activity at sites of disease activity. N Engl J Med 1981; 305 (8) 429-434
    CrossrefPubMedGoogle Scholar
  • 6 Du Bois RM, Kirby M, Balbi B, Saltini C, Crystal RG. T-lymphocytes that accumulate in the lung in sarcoidosis have evidence of recent stimulation of the T-cell antigen receptor. Am Rev Respir Dis 1992; 145 (5) 1205-1211
    CrossrefPubMedGoogle Scholar
  • 7 Rossman MD, Kreider ME. Is chronic beryllium disease sarcoidosis of known etiology?. Sarcoidosis Vasc Diffuse Lung Dis 2003; 20 (2) 104-109
    PubMedGoogle Scholar
  • 8 Rossman MD. Chronic beryllium disease: diagnosis and management. Environ Health Perspect 1996; 104 (Suppl. 05) 945-947
    CrossrefPubMedGoogle Scholar
  • 9 Williams WJ, Williams WR. Value of beryllium lymphocyte transformation tests in chronic beryllium disease and in potentially exposed workers. Thorax 1983; 38 (1) 41-44
    CrossrefPubMedGoogle Scholar
  • 10 Newman LS. Significance of the blood beryllium lymphocyte proliferation test. Environ Health Perspect 1996; 104 (Suppl. 05) 953-956
    CrossrefPubMedGoogle Scholar
  • 11 Curtis GH. Cutaneous hypersensitivity due to beryllium; a study of thirteen cases. AMA Arch Derm Syphilol 1951; 64 (4) 470-482
    CrossrefPubMedGoogle Scholar
  • 12 Müller-Quernheim J, Gaede KI, Fireman E, Zissel G. Diagnoses of chronic beryllium disease within cohorts of sarcoidosis patients. Eur Respir J 2006; 27 (6) 1190-1195
    CrossrefPubMedGoogle Scholar
  • 13 Fireman E, Haimsky E, Noiderfer M, Priel I, Lerman Y. Misdiagnosis of sarcoidosis in patients with chronic beryllium disease. Sarcoidosis Vasc Diffuse Lung Dis 2003; 20 (2) 144-148
    PubMedGoogle Scholar
  • 14 Newman LS, Kreiss K. Nonoccupational beryllium disease masquerading as sarcoidosis: identification by blood lymphocyte proliferative response to beryllium. Am Rev Respir Dis 1992; 145 (5) 1212-1214
    CrossrefPubMedGoogle Scholar
  • 15 Hardy HL. Differential diagnosis between beryllium poisoning and sarcoidosis. Am Rev Tuberc 1956; 74 (6) 885-896
    PubMedGoogle Scholar
  • 16 Redding RA, Hardy HL, Gaensler EA. Beryllium disease: a 16-year follow-up case study. Respiration 1968; 25 (3) 263-278
    CrossrefPubMedGoogle Scholar
  • 17 Hardy HL, Tabershaw IR. Delayed chemical pneumonitis occurring in workers exposed to beryllium compounds. J Ind Hyg Toxicol 1946; 28: 197-211
    PubMedGoogle Scholar
  • 18 Sprince NL, Kazemi H, Hardy HL. Current (1975) problem of differentiating between beryllium disease and sarcoidosis. Ann N Y Acad Sci 1976; 278: 654-664
    CrossrefPubMedGoogle Scholar
  • 19 Balkissoon RC, Newman LS. Beryllium copper alloy (2%) causes chronic beryllium disease. J Occup Environ Med 1999; 41 (4) 304-308
    CrossrefPubMedGoogle Scholar
  • 20 Kelleher PC, Martyny JW, Mroz MM , et al. Beryllium particulate exposure and disease relations in a beryllium machining plant. J Occup Environ Med 2001; 43 (3) 238-249
    CrossrefPubMedGoogle Scholar
  • 21 Maier LA, Martyny JW, Liang J, Rossman MD. Recent chronic beryllium disease in residents surrounding a beryllium facility. Am J Respir Crit Care Med 2008; 177 (9) 1012-1017
    CrossrefPubMedGoogle Scholar
  • 22 Lieben J, Metzner F. Epidemiological findings associated with beryllium extraction. Am Ind Hyg Assoc J 1959; 20: 494-499
    CrossrefPubMedGoogle Scholar
  • 23 Williams CR. Evaluation of exposure data in the beryllium registry; their relation to present maximum allowable concentrations. AMA Arch Ind Health 1959; 19 (2) 263-267
    PubMedGoogle Scholar
  • 24 Hasan FM, Kazemi H. Chronic beryllium disease: a continuing epidemiologic hazard. Chest 1974; 65 (3) 289-293
    CrossrefPubMedGoogle Scholar
  • 25 Hardy HL, Rabe EW, Lorch S. United States, Beryllium Case Registry (1952-1966). Review of its methods and utility. J Occup Med 1967; 9 (6) 271-276
    PubMedGoogle Scholar
  • 26 Peyton MF, Worcester J. Exposure data and epidemiology of the beryllium case registry, 1958. AMA Arch Ind Health 1959; 19 (2) 94-99
    PubMedGoogle Scholar
  • 27 Eisenbud M, Lisson J. Epidemiological aspects of beryllium-induced nonmalignant lung disease: a 30-year update. J Occup Med 1983; 25 (3) 196-202
    CrossrefPubMedGoogle Scholar
  • 28 Cullen MR, Kominsky JR, Rossman MD , et al. Chronic beryllium disease in a precious metal refinery. Clinical epidemiologic and immunologic evidence for continuing risk from exposure to low level beryllium fume. Am Rev Respir Dis 1987; 135 (1) 201-208
    PubMedGoogle Scholar
  • 29 Kreiss K, Newman LS, Mroz MM, Campbell PA. Screening blood test identifies subclinical beryllium disease. J Occup Med 1989; 31 (7) 603-608
    CrossrefPubMedGoogle Scholar
  • 30 Henneberger PK, Goe SK, Miller WE, Doney B, Groce DW. Industries in the United States with airborne beryllium exposure and estimates of the number of current workers potentially exposed. J Occup Environ Hyg 2004; 1 (10) 648-659
    CrossrefPubMedGoogle Scholar
  • 31 Van Dyke MV, Martyny JW, Mroz MM , et al. Exposure and genetics increase risk of beryllium sensitisation and chronic beryllium disease in the nuclear weapons industry. Occup Environ Med 2011; 68 (11) 842-848
    CrossrefPubMedGoogle Scholar
  • 32 Van Dyke MV, Martyny JW, Mroz MM , et al. Risk of chronic beryllium disease by HLA-DPB1 E69 genotype and beryllium exposure in nuclear workers. Am J Respir Crit Care Med 2011; 183 (12) 1680-1688
    CrossrefPubMedGoogle Scholar
  • 33 Taiwo OA, Slade MD, Cantley LF , et al. Beryllium sensitization in aluminum smelter workers. J Occup Environ Med 2008; 50 (2) 157-162
    CrossrefPubMedGoogle Scholar
  • 34 Schuler CR, Kitt MM, Henneberger PK, Deubner DC, Kreiss K. Cumulative sensitization and disease in a beryllium oxide ceramics worker cohort. J Occup Environ Med 2008; 50 (12) 1343-1350
    CrossrefPubMedGoogle Scholar
  • 35 Kreiss K, Wasserman S, Mroz MM, Newman LS. Beryllium disease screening in the ceramics industry. Blood lymphocyte test performance and exposure-disease relations. J Occup Med 1993; 35 (3) 267-274
    PubMedGoogle Scholar
  • 36 Stange AW, Hilmas DE, Furman FJ. Possible health risks from low level exposure to beryllium. Toxicology 1996; 111 (1-3) 213-224
    CrossrefPubMedGoogle Scholar
  • 37 Kreiss K, Mroz MM, Newman LS, Martyny J, Zhen B. Machining risk of beryllium disease and sensitization with median exposures below 2 micrograms/m3 . Am J Ind Med 1996; 30 (1) 16-25
    CrossrefPubMedGoogle Scholar
  • 38 Kreiss K, Mroz MM, Zhen B, Wiedemann H, Barna B. Risks of beryllium disease related to work processes at a metal, alloy, and oxide production plant. Occup Environ Med 1997; 54 (8) 605-612
    CrossrefPubMedGoogle Scholar
  • 39 Newman LS, Mroz MM, Maier LA, Daniloff EM, Balkissoon R. Efficacy of serial medical surveillance for chronic beryllium disease in a beryllium machining plant. J Occup Environ Med 2001; 43 (3) 231-237
    CrossrefPubMedGoogle Scholar
  • 40 Henneberger PK, Cumro D, Deubner DD, Kent MS, McCawley M, Kreiss K. Beryllium sensitization and disease among long-term and short-term workers in a beryllium ceramics plant. Int Arch Occup Environ Health 2001; 74 (3) 167-176
    CrossrefPubMedGoogle Scholar
  • 41 Deubner DC, Goodman M, Iannuzzi J. Variability, predictive value, and uses of the beryllium blood lymphocyte proliferation test (BLPT): preliminary analysis of the ongoing workforce survey. Appl Occup Environ Hyg 2001; 16 (5) 521-526
    CrossrefPubMedGoogle Scholar
  • 42 Sackett HM, Maier LA, Silveira LJ , et al. Beryllium medical surveillance at a former nuclear weapons facility during cleanup operations. J Occup Environ Med 2004; 46 (9) 953-961
    CrossrefPubMedGoogle Scholar
  • 43 Schuler CR, Kent MS, Deubner DC , et al. Process-related risk of beryllium sensitization and disease in a copper-beryllium alloy facility. Am J Ind Med 2005; 47 (3) 195-205
    CrossrefPubMedGoogle Scholar
  • 44 Welch L, Ringen K, Bingham E , et al. Screening for beryllium disease among construction trade workers at Department of Energy nuclear sites. Am J Ind Med 2004; 46 (3) 207-218
    CrossrefPubMedGoogle Scholar
  • 45 Rosenman K, Hertzberg V, Rice C , et al. Chronic beryllium disease and sensitization at a beryllium processing facility. Environ Health Perspect 2005; 113 (10) 1366-1372
    CrossrefPubMedGoogle Scholar
  • 46 Stange AW, Hilmas DE, Furman FJ, Gatliffe TR. Beryllium sensitization and chronic beryllium disease at a former nuclear weapons facility. Appl Occup Environ Hyg 2001; 16 (3) 405-417
    CrossrefPubMedGoogle Scholar
  • 47 Kreiss K, Mroz MM, Zhen B, Martyny JW, Newman LS. Epidemiology of beryllium sensitization and disease in nuclear workers. Am Rev Respir Dis 1993; 148 (4 Pt 1) 985-991
    CrossrefPubMedGoogle Scholar
  • 48 Newman LS, Mroz MM, Balkissoon R, Maier LA. Beryllium sensitization progresses to chronic beryllium disease: a longitudinal study of disease risk. Am J Respir Crit Care Med 2005; 171 (1) 54-60
    CrossrefPubMedGoogle Scholar
  • 49 Bailey RL, Thomas CA, Deubner DC, Kent MS, Kreiss K, Schuler CR. Evaluation of a preventive program to reduce sensitization at a beryllium metal, oxide, and alloy production plant. J Occup Environ Med 2010; 52 (5) 505-512
    CrossrefPubMedGoogle Scholar
  • 50 Thomas CA, Bailey RL, Kent MS, Deubner DC, Kreiss K, Schuler CR. Efficacy of a program to prevent beryllium sensitization among new employees at a copper-beryllium alloy processing facility. Public Health Rep 2009; 124 (Suppl. 01) 112-124
    PubMedGoogle Scholar
  • 51 Eisenbud M. The standard for control of chronic beryllium disease. Appl Occup Environ Hyg 1998; 13: 25-31
    CrossrefPubMedGoogle Scholar
  • 52 Glazer CS, Rose CS, Lynch DA. Clinical and radiologic manifestations of hypersensitivity pneumonitis. J Thorac Imaging 2002; 17 (4) 261-272
    CrossrefPubMedGoogle Scholar
  • 53 Tillie-Leblond I, Grenouillet F, Reboux G , et al. Hypersensitivity pneumonitis and metalworking fluids contaminated by mycobacteria. Eur Respir J 2011; 37 (3) 640-647
    CrossrefPubMedGoogle Scholar
  • 54 Marinelli WA, Davies SF. Granulomatous diseases of the lung that mimic respiratory infections. Semin Respir Infect 1988; 3 (3) 181-202
    PubMedGoogle Scholar
  • 55 Newman LS, Rose CS, Bresnitz EA , et al; ACCESS Research Group. A case control etiologic study of sarcoidosis: environmental and occupational risk factors. Am J Respir Crit Care Med 2004; 170 (12) 1324-1330
    CrossrefPubMedGoogle Scholar
  • 56 Prezant DJ, Dhala A, Goldstein A , et al. The incidence, prevalence, and severity of sarcoidosis in New York City firefighters. Chest 1999; 116 (5) 1183-1193
    CrossrefPubMedGoogle Scholar
  • 57 Kern DG, Neill MA, Wrenn DS, Varone JC. Investigation of a unique time-space cluster of sarcoidosis in firefighters. Am Rev Respir Dis 1993; 148 (4 Pt 1) 974-980
    CrossrefPubMedGoogle Scholar
  • 58 Kucera GP, Rybicki BA, Kirkey KL , et al. Occupational risk factors for sarcoidosis in African-American siblings. Chest 2003; 123 (5) 1527-1535
    CrossrefPubMedGoogle Scholar
  • 59 Gorham ED, Garland CF, Garland FC, Kaiser K, Travis WD, Centeno JA. Trends and occupational associations in incidence of hospitalized pulmonary sarcoidosis and other lung diseases in Navy personnel: a 27-year historical prospective study, 1975-2001. Chest 2004; 126 (5) 1431-1438
    CrossrefPubMedGoogle Scholar
  • 60 Rossman MD, Thompson B, Frederick M , et al; ACCESS Group. HLA and environmental interactions in sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis 2008; 25 (2) 125-132
    PubMedGoogle Scholar
  • 61 Barnard J, Rose C, Newman L , et al; ACCESS Research Group. Job and industry classifications associated with sarcoidosis in A Case-Control Etiologic Study of Sarcoidosis (ACCESS). J Occup Environ Med 2005; 47 (3) 226-234
    CrossrefPubMedGoogle Scholar
  • 62 Hardy HL. The definition of sarcoidosis. Am Rev Respir Dis 1961; 84 (5) 1-5
    PubMedGoogle Scholar
  • 63 Centers for Disease Control and Prevention (CDC). Sarcoidosis among U.S. Navy enlisted men, 1965-1993. MMWR Morb Mortal Wkly Rep 1997; 46 (23) 539-543
    PubMedGoogle Scholar
  • 64 Rafnsson V, Ingimarsson O, Hjalmarsson I, Gunnarsdottir H. Association between exposure to crystalline silica and risk of sarcoidosis. Occup Environ Med 1998; 55 (10) 657-660
    CrossrefPubMedGoogle Scholar
  • 65 Drent M, Bomans PH, Van Suylen RJ, Lamers RJ, Bast A, Wouters EF. Association of man-made mineral fibre exposure and sarcoidlike granulomas. Respir Med 2000; 94 (8) 815-820
    CrossrefPubMedGoogle Scholar
  • 66 Bowers B, Hasni S, Gruber BL. Sarcoidosis in World Trade Center rescue workers presenting with rheumatologic manifestations. J Clin Rheumatol 2010; 16 (1) 26-27
    CrossrefPubMedGoogle Scholar
  • 67 Izbicki G, Chavko R, Banauch GI , et al. World Trade Center “sarcoid-like” granulomatous pulmonary disease in New York City Fire Department rescue workers. Chest 2007; 131 (5) 1414-1423
    CrossrefPubMedGoogle Scholar
  • 68 Crowley LE, Herbert R, Moline JM , et al. “Sarcoid like” granulomatous pulmonary disease in World Trade Center disaster responders. Am J Ind Med 2011; 54 (3) 175-184
    CrossrefPubMedGoogle Scholar
  • 69 Jordan HT, Stellman SD, Prezant D, Teirstein A, Osahan SS, Cone JE. Sarcoidosis diagnosed after September 11, 2001, among adults exposed to the World Trade Center disaster. J Occup Environ Med 2011; 53 (9) 966-974
    CrossrefPubMedGoogle Scholar
  • 70 Dourado L, Kawassaki AM, Baldi BG , et al. Is silica exposure a precipitating agent of pulmonary sarcoidosis?. American Thoracic Society International Conference. New Orleans, LA, 2010
    PubMedGoogle Scholar
  • 71 Douglas JG, Middleton WG, Gaddie J , et al. Sarcoidosis: a disorder commoner in non-smokers?. Thorax 1986; 41 (10) 787-791
    CrossrefPubMedGoogle Scholar
  • 72 Gerke AK, van Beek E, Hunninghake GW. Smoking inhibits the frequency of bronchovascular bundle thickening in sarcoidosis. Acad Radiol 2011; 18 (7) 885-891
    CrossrefPubMedGoogle Scholar
  • 73 Sato H, Silveira L, Fingerlin T , et al. TNF polymorphism and bronchoalveolar lavage cell TNF-α levels in chronic beryllium disease and beryllium sensitization. J Allergy Clin Immunol 2007; 119 (3) 687-696
    CrossrefPubMedGoogle Scholar
  • 74 Yeager H, Gopalan S, Mathew P, Lawless O, Bellanti JA. Sarcoidosis: can a murine model help define a role for silica?. Med Hypotheses 2012; 78 (1) 36-38
    CrossrefPubMedGoogle Scholar
  • 75 Selman M, Pardo A, King Jr TE. Hypersensitivity pneumonitis: insights in diagnosis and pathobiology. Am J Respir Crit Care Med 2012; 186 (4) 314-324
    CrossrefPubMedGoogle Scholar
  • 76 Van Ordstrand HS, Hughes R, Carmody MG. Chemical pneumonia in workers extracting beryllium oxide: Report of three cases. Cleve Clin Q 1943; 10: 10-18
    CrossrefPubMedGoogle Scholar
  • 77 Van Ordstrand HS, Hughes R, DeNardi JM, Carmody MG. Beryllium poisoning. J Am Med Assoc 1945; 129: 1084-1090
    CrossrefPubMedGoogle Scholar
  • 78 Denardi JM, Van Ordstrand HS, Curtis GH, Zielinski J. Berylliosis; summary and survey of all clinical types observed in a twelve-year period. AMA Arch Ind Hyg Occup Med 1953; 8 (1) 1-24
    PubMedGoogle Scholar
  • 79 Van Ordstrand HS. Current concepts of beryllium poisoning. Ann Intern Med 1951; 35 (6) 1203-1217
    CrossrefPubMedGoogle Scholar
  • 80 Tepper LB, Hardy HL, Chamberlin RI. Toxicity of beryllium compounds. In: Browning E, , ed. Elsevier Monographs on Toxic Agents. Amsterdam: Elsevier Publishing Company; 1961: 132-145
    Google Scholar
  • 81 Hardy HL. Beryllium poisoning—lessons in control of man-made disease. N Engl J Med 1965; 273 (22) 1188-1199
    CrossrefPubMedGoogle Scholar
  • 82 Van Ordstrand HS. Diagnosis of beryllium disease. AMA Arch Ind Health 1959; 19 (2) 157-159
    PubMedGoogle Scholar
  • 83 Cummings KJ, Deubner DC, Day GA , et al. Enhanced preventive programme at a beryllium oxide ceramics facility reduces beryllium sensitisation among new workers. Occup Environ Med 2007; 64 (2) 134-140
    PubMedGoogle Scholar
  • 84 Keary PJ, Palmer DG. Benign self-limiting sarcoidosis with skin and joint involvement. N Z Med J 1976; 83 (560) 197-199
    PubMedGoogle Scholar
  • 85 Stoeckle JD, Hardy HL, Weber AL. Chronic beryllium disease. Long-term follow-up of sixty cases and selective review of the literature. Am J Med 1969; 46 (4) 545-561
    CrossrefPubMedGoogle Scholar
  • 86 Tepper LB. Beryllium. Crit Rev Toxicol 1972; 1: 235-259
    CrossrefPubMedGoogle Scholar
  • 87 Freiman DG, Hardy HL. Beryllium disease. The relation of pulmonary pathology to clinical course and prognosis based on a study of 130 cases from the U.S. beryllium case registry. Hum Pathol 1970; 1 (1) 25-44
    CrossrefPubMedGoogle Scholar
  • 88 Newman LS, Kreiss K, King Jr TE, Seay S, Campbell PA. Pathologic and immunologic alterations in early stages of beryllium disease. Re-examination of disease definition and natural history. Am Rev Respir Dis 1989; 139 (6) 1479-1486
    CrossrefPubMedGoogle Scholar
  • 89 Pappas GP, Newman LS. Early pulmonary physiologic abnormalities in beryllium disease. Am Rev Respir Dis 1993; 148 (3) 661-666
    CrossrefPubMedGoogle Scholar
  • 90 Newman LS. Immunology, genetics, and epidemiology of beryllium disease. Chest 1996; 109 (3, Suppl): 40S-43S
    CrossrefPubMedGoogle Scholar
  • 91 Mroz MM, Maier LA, Strand M, Silviera L, Newman LS. Beryllium lymphocyte proliferation test surveillance identifies clinically significant beryllium disease. Am J Ind Med 2009; 52 (10) 762-773
    CrossrefPubMedGoogle Scholar
  • 92 Cullen MR, Cherniack MG, Kominsky JR. Chronic beryllium disease in the United States. Sem Respir Med 1986; 7: 203-209
    Article in Thieme ConnectPubMedGoogle Scholar
  • 93 Andrews JL, Kazemi H, Hardy HL. Patterns of lung dysfunction in chronic beryllium disease. Am Rev Respir Dis 1969; 100 (6) 791-800
    PubMedGoogle Scholar
  • 94 Lundgren RA, Maier LA, Rose CS, Balkissoon RC, Newman LS. Indirect and direct gas exchange at maximum exercise in beryllium sensitization and disease. Chest 2001; 120 (5) 1702-1708
    CrossrefPubMedGoogle Scholar
  • 95 Robert AG. A consideration of the roentgen diagnosis of chronic pulmonary granulomatosis of beryllium workers. AJR 1950; 63: 467-487
    PubMedGoogle Scholar
  • 96 Aronchick JM, Rossman MD, Miller WT. Chronic beryllium disease: diagnosis, radiographic findings, and correlation with pulmonary function tests. Radiology 1987; 163 (3) 677-682
    CrossrefPubMedGoogle Scholar
  • 97 Kline EM, Inkley SR, Pritchard WH. Five cases from the fluorescent lamp industry; treatment of chronic beryllium poisoning with ACTH and cortisone. AMA Arch Ind Hyg Occup Med 1951; 3 (6) 549-564
    PubMedGoogle Scholar
  • 98 Newman LS, Buschman DL, Newell Jr JD, Lynch DA. Beryllium disease: assessment with CT. Radiology 1994; 190 (3) 835-840
    CrossrefPubMedGoogle Scholar
  • 99 Daniloff EM, Lynch DA, Bartelson BB, Newell Jr JD, Bernstein SM, Newman LS. Observer variation and relationship of computed tomography to severity of beryllium disease. Am J Respir Crit Care Med 1997; 155 (6) 2047-2056
    CrossrefPubMedGoogle Scholar
  • 100 Sood A, Beckett WS, Cullen MR. Variable response to long-term corticosteroid therapy in chronic beryllium disease. Chest 2004; 126 (6) 2000-2007
    CrossrefPubMedGoogle Scholar
  • 101 Marchand-Adam S, El Khatib A, Guillon F , et al. Short- and long-term response to corticosteroid therapy in chronic beryllium disease. Eur Respir J 2008; 32 (3) 687-693
    CrossrefPubMedGoogle Scholar
  • 102 Sprince NL, Kanarek DJ, Weber AL, Chamberlin RI, Kazemi H. Reversible respiratory disease in beryllium workers. Am Rev Respir Dis 1978; 117 (6) 1011-1017
    PubMedGoogle Scholar
  • 103 Kline EM, Moir TW. Long-term experience with beryllium disease; a report of twenty patients. AMA Arch Ind Health 1959; 19 (2) 104-109
    PubMedGoogle Scholar
  • 104 Chesner C. Chronic pulmonary granulomatosis in residents of a community near a beryllium plant; 3 autopsied cases. Ann Intern Med 1950; 32 (6) 1028-1048
    CrossrefPubMedGoogle Scholar
  • 105 Baughman RP, Lower EE. Infliximab for refractory sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis 2001; 18 (1) 70-74
    PubMedGoogle Scholar
  • 106 Alhamad EH, Lynch III JP, Martinez FJ. Pulmonary function tests in interstitial lung disease: what role do they have?. Clin Chest Med 2001; 22 (4) 715-750 , ix
    CrossrefPubMedGoogle Scholar
  • 107 Nishino M, Lee KS, Itoh H, Hatabu H. The spectrum of pulmonary sarcoidosis: variations of high-resolution CT findings and clues for specific diagnosis. Eur J Radiol 2010; 73 (1) 66-73
    CrossrefPubMedGoogle Scholar
  • 108 Vilaplana J, Romaguera C, Grimalt F. Occupational and non-occupational allergic contact dermatitis from beryllium. Contact Dermat 1992; 26 (5) 295-298
    CrossrefPubMedGoogle Scholar
  • 109 Haberman AL, Pratt M, Storrs FJ. Contact dermatitis from beryllium in dental alloys. Contact Dermat 1993; 28 (3) 157-162
    CrossrefPubMedGoogle Scholar
  • 110 Van Ordstrand HS, Netherton EW, DeNardi JM, Carmody MG. Beryllium skin granulomas from a broken fluorescent tube; report of a case. Cleve Clin Q 1950; 17 (1) 47-54, illust
    PubMedGoogle Scholar
  • 111 DeNardi JM. Berylliosis (beryllium poisoning). Cur Ther 1958; 714-717
    PubMedGoogle Scholar
  • 112 Collin B, Rajaratnam R, Lim R, Lewis H. A retrospective analysis of 34 patients with cutaneous sarcoidosis assessed in a dermatology department. Clin Exp Dermatol 2010; 35 (2) 131-134
    CrossrefPubMedGoogle Scholar
  • 113 Lodha S, Sanchez M, Prystowsky S. Sarcoidosis of the skin: a review for the pulmonologist. Chest 2009; 136 (2) 583-596
    CrossrefPubMedGoogle Scholar
  • 114 Rose AS, Tielker MA, Knox KS. Hepatic, ocular, and cutaneous sarcoidosis. Clin Chest Med 2008; 29 (3) 509-524 , ix
    CrossrefPubMedGoogle Scholar
  • 115 Ali MM, Atwan AA, Gonzalez ML. Cutaneous sarcoidosis: updates in the pathogenesis. J Eur Acad Dermatol Venereol 2010; 24 (7) 747-755
    PubMedGoogle Scholar
  • 116 Stange AW, Furman FJ, Hilmas DE. The beryllium lymphocyte proliferation test: Relevant issues in beryllium health surveillance. Am J Ind Med 2004; 46 (5) 453-462
    CrossrefPubMedGoogle Scholar
  • 117 Maier LA. Beryllium health effects in the era of the beryllium lymphocyte proliferation test. Appl Occup Environ Hyg 2001; 16 (5) 514-520
    CrossrefPubMedGoogle Scholar
  • 118 Frome EL, Newman LS, Cragle DL, Colyer SP, Wambach PF. Identification of an abnormal beryllium lymphocyte proliferation test. Toxicology 2003; 183 (1-3) 39-56
    CrossrefPubMedGoogle Scholar
  • 119 Middleton DC, Fink J, Kowalski PJ, Lewin MD, Sinks T. Optimizing BeLPT criteria for beryllium sensitization. Am J Ind Med 2008; 51 (3) 166-172
    CrossrefPubMedGoogle Scholar
  • 120 Siltzbach LE. The Kveim test in sarcoidosis. A study of 750 patients. JAMA 1961; 178: 476-482
    CrossrefPubMedGoogle Scholar
  • 121 Munro CS, Mitchell DN. The K veim response: still useful, still a puzzle. Thorax 1987; 42 (5) 321-331
    CrossrefPubMedGoogle Scholar
  • 122 Ribeiro M, Fritscher LG, Al-Musaed AM , et al. Search for chronic beryllium disease among sarcoidosis patients in Ontario, Canada. Lung 2011; 189 (3) 233-241
    CrossrefPubMedGoogle Scholar
  • 123 NIOSH. Response to Health Hazard Evaluation request by NIOSH from Management of the U.S. G.S.A Bannister Federal Complex in Kansas City, MO. In: Services DoHaH, ed. Vol. HETA 2010–0061: NIOSH, 2011
    Google Scholar
  • 124 Newman LS, Mroz MM, Schumacher B, Daniloff E, Kreiss K. Beryllium sensitization precedes chronic beryllium disease. Am Rev Respir Dis (Suppl) 1992; 145: A324
    PubMedGoogle Scholar
  • 125 Bill JR, Mack DG, Falta MT , et al. Beryllium presentation to CD4+ T cells is dependent on a single amino acid residue of the MHC class II beta-chain. J Immunol 2005; 175 (10) 7029-7037
    CrossrefPubMedGoogle Scholar
  • 126 Richeldi L, Sorrentino R, Saltini C. HLA-DPB1 glutamate 69: a genetic marker of beryllium disease. Science 1993; 262 (5131) 242-244
    CrossrefPubMedGoogle Scholar
  • 127 Weston A, Ensey J, Kreiss K, Keshava C, McCanlies E. Racial differences in prevalence of a supratypic HLA-genetic marker immaterial to pre-employment testing for susceptibility to chronic beryllium disease. Am J Ind Med 2002; 41 (6) 457-465
    CrossrefPubMedGoogle Scholar
  • 128 Fontenot AP, Torres M, Marshall WH, Newman LS, Kotzin BL. Beryllium presentation to CD4+ T cells underlies disease-susceptibility HLA-DP alleles in chronic beryllium disease. Proc Natl Acad Sci U S A 2000; 97 (23) 12717-12722
    CrossrefPubMedGoogle Scholar
  • 129 Sawyer RT, Doherty DE, Schumacher BA, Newman LS. Beryllium-stimulated in vitro migration of peripheral blood lymphocytes. Toxicology 1999; 138 (3) 155-163
    CrossrefPubMedGoogle Scholar
  • 130 Fontenot AP, Falta MT, Freed BM, Newman LS, Kotzin BL. Identification of pathogenic T cells in patients with beryllium-induced lung disease. J Immunol 1999; 163 (2) 1019-1026
    PubMedGoogle Scholar
  • 131 Rossman MD, Kern JA, Elias JA , et al. Proliferative response of bronchoalveolar lymphocytes to beryllium. A test for chronic beryllium disease. Ann Intern Med 1988; 108 (5) 687-693
    CrossrefPubMedGoogle Scholar
  • 132 Tinkle SS, Schwitters PW, Newman LS. Cytokine production by bronchoalveolar lavage cells in chronic beryllium disease. Environ Health Perspect 1996; 104 (Suppl. 05) 969-971
    CrossrefPubMedGoogle Scholar
  • 133 Fontenot AP, Canavera SJ, Gharavi L, Newman LS, Kotzin BL. Target organ localization of memory CD4(+) T cells in patients with chronic beryllium disease. J Clin Invest 2002; 110 (10) 1473-1482
    CrossrefPubMedGoogle Scholar
  • 134 Jonth AC, Silveira L, Fingerlin TE , et al; ACCESS Group. TGF-beta 1 variants in chronic beryllium disease and sarcoidosis. J Immunol 2007; 179 (6) 4255-4262
    CrossrefPubMedGoogle Scholar
  • 135 Sato H, Silveira L, Spagnolo P , et al. CC chemokine receptor 5 gene polymorphisms in beryllium disease. Eur Respir J 2010; 36 (2) 331-338
    CrossrefPubMedGoogle Scholar
  • 136 Bekris LM, Viernes HM, Farin FM, Maier LA, Kavanagh TJ, Takaro TK. Chronic beryllium disease and glutathione biosynthesis genes. J Occup Environ Med 2006; 48 (6) 599-606
    CrossrefPubMedGoogle Scholar
  • 137 Gerke AK, Hunninghake G. The immunology of sarcoidosis. Clin Chest Med 2008; 29 (3) 379-390 , vii
    CrossrefPubMedGoogle Scholar
  • 138 Spagnolo P, Grunewald J. Recent advances in the genetics of sarcoidosis. J Med Genet 2013; 50 (5) 290-297
    CrossrefPubMedGoogle Scholar
  • 139 Grunewald J. Review: role of genetics in susceptibility and outcome of sarcoidosis. Semin Respir Crit Care Med 2010; 31 (4) 380-389
    Article in Thieme ConnectPubMedGoogle Scholar
  • 140 Spagnolo P, Renzoni EA, Wells AU , et al. C-C chemokine receptor 5 gene variants in relation to lung disease in sarcoidosis. Am J Respir Crit Care Med 2005; 172 (6) 721-728
    CrossrefPubMedGoogle Scholar
  • 141 Maier LA, Barkes BQ, Mroz M , et al. Infliximab therapy modulates an antigen-specific immune response in chronic beryllium disease. Respir Med 2012; 106 (12) 1810-1813
    CrossrefPubMedGoogle Scholar
  • 142 Paramothayan NS, Lasserson TJ, Jones PW. Corticosteroids for pulmonary sarcoidosis. Cochrane Database Syst Rev 2005; (2) CD001114
    PubMedGoogle Scholar
  • 143 Paramothayan S, Lasserson TJ, Walters EH. Immunosuppressive and cytotoxic therapy for pulmonary sarcoidosis. Cochrane Database Syst Rev 2006; (3) CD003536
    PubMedGoogle Scholar
  • 144 Baughman RP, Drent M, Kavuru M , et al; Sarcoidosis Investigators. Infliximab therapy in patients with chronic sarcoidosis and pulmonary involvement. Am J Respir Crit Care Med 2006; 174 (7) 795-802
    CrossrefPubMedGoogle Scholar
  • 145 Sahoo DH, Bandyopadhyay D, Xu M , et al. Effectiveness and safety of leflunomide for pulmonary and extrapulmonary sarcoidosis. Eur Respir J 2011; 38 (5) 1145-1150
    CrossrefPubMedGoogle Scholar