The full content of Annals is available to subscribers

Subscribe/Learn More  >
Original Research |

Flock Worker's Lung: Chronic Interstitial Lung Disease in the Nylon Flocking Industry

David G. Kern, MD, MOH; Robert S. Crausman, MD; Kate T.H. Durand, MHS, CIH; Ali Nayer, MD; and Charles Kuhn III, MD
[+] Article, Author, and Disclosure Information

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1998;129(4):261-272. doi:10.7326/0003-4819-129-4-199808150-00001
Text Size: A A A

Background: Two young men working at a nylon flocking plant in Rhode Island developed interstitial lung disease of unknown cause. Similar clusters at the same company's Canadian plant were reported previously.

Objective: To define the extent, clinicopathologic features, and potential causes of the apparent disease outbreak.

Design: Case-finding survey and retrospective cohort study.

Setting: Academic occupational medicine program.

Patients: All workers employed at the Rhode Island plant on or after 15 June 1990.

Measurements: Symptomatic employees had chest radiography, pulmonary function tests, high-resolution computed tomography, and serologic testing. Those with unexplained radiographic or pulmonary function abnormalities underwent bronchoalveolar lavage, lung biopsy, or both. The case definition of “flock worker's lung” required histologic evidence of interstitial lung disease (or lavage evidence of lung inflammation) not explained by another condition.

Results: Eight cases of flock worker's lung were identified at the Rhode Island plant. Three cases were characterized by a high proportion of eosinophils (25% to 40%) in lavage fluid. Six of the seven patients who had biopsy had histologic findings of nonspecific interstitial pneumonia, and the seventh had bronchiolitis obliterans organizing pneumonia. All seven of these patients had peribronchovascular interstitial lymphoid nodules, usually with germinal centers, and most had lymphocytic bronchiolitis and interstitial fibrosis. All improved after leaving work. Review of the Canadian tissue specimens showed many similar histologic findings. Among the 165-member study cohort, a 48-fold or greater increase was seen in the sex-adjusted incidence rate of all interstitial lung disease.

Conclusions: Work in the nylon flocking industry poses substantial risk for a previously unrecognized occupational interstitial lung disease. Nylon fiber is the suspected cause of this condition.


Grahic Jump Location
Figure 1.
Distribution of study participants by extent of evaluation.

Two additional former employees who were not members of the cohort were also clinically evaluated.

Grahic Jump Location
Grahic Jump Location
Figure 2.
Patient 4.arrows

A. High-resolution computed tomographic scan showing micronodularity and patchy areas of mild ground-glass opacity. B. Open-lung biopsy specimen showing nodules of lymphocytes ( ) in inflamed and consolidated parenchyma (hematoxylin-eosin stain; original magnification, x96).

Grahic Jump Location
Grahic Jump Location
Figure 3.
Patient 5.asterisk

A. High-resolution computed tomographic scan showing patchy areas of subtle ground-glass opacity. B. Transbronchial biopsy specimen showing lymphocytic infiltration of a bronchiole and a germinal center ( ) (hematoxylin-eosin stain; original magnification, x83).

Grahic Jump Location
Grahic Jump Location
Figure 4.
Patient 8.

A. High-resolution computed tomographic scan showing patchy areas of consolidation and ground-glass opacity. B. Open-lung biopsy specimen showing organizing fibrous tissue within alveoli (thick arrows) and widespread lymphocytic infiltrates with perivascular lymphoid nodules (thin arrows) (hematoxylin-eosin stain; original magnification, x96).

Grahic Jump Location
Grahic Jump Location
Figure 5.
Patient 2.arrow

A. High-resolution computed tomographic scan showing diffuse reticular densities and honeycombing consistent with interstitial fibrosis. B. Open-lung biopsy specimen showing a longitudinally sectioned bronchiole with severe lymphocytic bronchiolitis and parenchymal infiltrates (lower right) (hematoxylin-eosin stain; original magnification, x38). C. Higher magnification of a region similar to the lower right portion of panel B, showing lymphocytic infiltration of alveolar walls ( ) and intra-alveolar macrophages and multinucleated giant cells (hematoxylin-eosin stain; original magnification, x380).

Grahic Jump Location




Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $32.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.