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Hypersensitivity Pneumonitis Induced by Toluene Diisocyanate: Sequelae of Continuous Exposure

Yasuyuki Yoshizawa, MD; Morio Ohtsuka, MD; Kenichi Noguchi, MD; Yoshiyuki Uchida, MD; Matsunobu Suko, MD; and Shizuo Hasegawa, MD
[+] Article and Author Information

Grant Support: Partial support by the Research Committee of the Japanese Ministry of Health and Welfare on Interstitial Pulmonary Diseases and by grants from the University of Tsukuba Project Research.

Requests for Reprints: Yasuyuki Yoshizawa, MD, Division of Pulmonary Medicine, Department of Internal Medicine, Institute of Clinical Medicine, University of Tsukuba, Tsukuba City, Ibaraki 305, Japan.

Current Author Addresses: Drs. Yoshizawa, Ohtsuka, Uchida, and Hasegawa: Division of Pulmonary Medicine, Department of Internal Medicine, Institute of Clinical Medicine, University of Tsukuba, Tsukuba City, Ibaraki 305, Japan.

Dr. Noguchi: Department of Internal Medicine, Jonan Hospital, Mito City Ibaraki 310, Japan.

Dr. Suko: Department of Medicine and Physical Therapy, University of Tokyo, Tokyo 113, Japan.


© 1989 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1989;110(1):31-34. doi:10.7326/0003-4819-110-1-31
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A 41-year-old automobile paint sprayer showed the clinical features of hypersensitivity pneumonitis 1 week after he had begun to work with paint materials containing toluene diisocyanate. His symptoms began 6 to 8 hours after exposure to the agent and spontaneously disappeared by the next morning. He had diffuse, fine reticulonodular shadows on a chest roentgenogram and a restrictive impairment of pulmonary function. Immunoglobulin G antibody to toluene diisocyanate-human serum albumin was present in bronchoalveolar lavage fluid and sera; IgA antibody was present only in bronchoalveolar lavage fluid. Also, the patient had sensitized bronchoalveolar lymphocytes to toluene diisocyanateserum albumin. The histologic findings suggested hypersensitivity pneumonitis. The results of bronchoalveolar lavage, which was repeated on four separate occasions, showed lymphocytosis and a predominance of suppressorcytotoxic T cells. The findings from serial determinations of humoral antibodies showed no changes consistent with the results of clinical and laboratory studies. In contrast, blastogenic responses of bronchoalveolar lymphocytes to toluene diisocyanate markedly decreased, and the patient showed clinical improvement despite continued exposure to the agent.

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