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Proliferative Response of Bronchoalveolar Lymphocytes to Beryllium: A Test for Chronic Beryllium Disease

MILTON D. ROSSMAN, M.D.; JEFFREY A. KERN, M.D.; JACK A. ELIAS, M.D.; MARK R. CULLEN, M.D.; PAUL E. EPSTEIN, M.D.; OTTO P. PREUSS, M.D.; THOMAS N. MARKHAM, M.D.; and RONALD P. DANIELE, M.D.
[+] Article and Author Information

Grant support: from the National Heart, Lung, and Blood Institute (HL-30715).

▸Requests for reprints should be addressed to Milton D. Rossman, M.D.; Rm. 811 East Gates Building, Hospital of the University of Pennsylvania, 3400 Spruce Street; Philadelphia, PA 19104-4283.


Philadelphia, Pennsylvania; New Haven, Connecticut; and Cleveland, Ohio


© 1988 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1988;108(5):687-693. doi:10.7326/0003-4819-108-5-687
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Study Objective: To ascertain whether measuring the proliferative response of bronchoalveolar lymphocytes to beryllium salts is useful for diagnosing chronic beryllium disease.

Design: Prospective case series compared to normal volunteers and patients with sarcoidosis.

Setting: University referral center.

Patients: Twenty-three consecutive beryllium workers were evaluated. Fourteen had chronic beryllium disease diagnosed on the basis of histologic evidence of a progressive pulmonary granulomatosis. Four had biopsy evidence of non-beryllium disease. Three had probable chronic beryllium disease but did not have lung biopsies. Two did not have biopsies and had basilar fibrosis on chest roentgenogram suggestive of non-beryllium lung disease. These patients were compared with 6 normal volunteers and 16 patients with sarcoidosis.

Measurements and Main Results: Bronchoalveolar lavage was done and the proliferative response of the lung cells to two beryllium salts was tested. A positive proliferative test was defined as a stimulation index of more than five on two determinations. The sensitivity of this test was 100% in the 14 patients with definite chronic beryllium disease. The specificity of the test was also 100% among the normal volunteers and the 16 patients with sarcoidosis. The test was positive in none of the four patients with biopsy evidence of non-beryllium disease, none out of two patients with lower lobe fibrosis suggestive of non-beryllium disease, and all of three patients with probable chronic beryllium lung disease.

Conclusions: The proliferative response of bronchoalveolar lymphocytes to beryllium appears to be a useful test for chronic beryllium disease.

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