Abstract
Inhalation of welding fumes including iron dust is a known cause of pulmonary siderosis or welder's lung. In some cases systemic iron overload has been reported as well. We present three cases of welder's lung with systemic iron overload.
Cases: Three patients in their sixties with a history of smoking and welding presented with dyspnea and cough. Two of them had COPD (Gold I en IV). In all three HRCT showed nodules and ground glass consolidation. Three different radiologic patterns were seen (i.e. RB-ILD, hypersensitivity pneumonitis ,and emphysema) together with an overload of iron stained macrophages in de broncho-alveolar fluid compatible with pulmonary siderosis. In two cases pulmonary siderosis was confirmed by lung biopsy. In all cases elevated serum ferritin was found with values two to seven times above the normal limit and in one case iron deposition in the liver. Genetic haemochromatosis and other underlying systemic diseases were excluded. Phlebotomy was started in one case.
Discussion: Health risks of occupational exposure to welding fumes should be considered despite the suggestion of a different pulmonary disease . In addition, systemic iron overload in pulmonary siderosis may occur as a result of iron dust inhalation. Iron dust is captured in the macrophages and transported throughout the body .
Conclusion: Systemic overload of iron may be present in welders with pulmonary siderosis and should be treated accordingly.
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