March 12, 2004 — Doctors sometimes have problems distinguishing between chronic beryllium disease and sarcoidosis, according to a recent review of the beryllium literature (Lancet 2004 Feb 7; 363(9407): 415–6; full text available for a fee). Sarcoidosis is a chronic disease of unknown cause marked by the formation of abnormal nodes in the lungs, lymph glands and other areas. Chronic beryllium disease is a painful scarring of the lungs caused by an allergic reaction to beryllium. The X–rays of a patient with either disease show lung “granulomas,” which are grainy–looking lumps or nodes of inflammatory cells. Both diseases present similar symptoms—cough, shortness of breath, exhaustion, and fever.

Determining whether a patient has chronic beryllium disease or sarcoidosis is helpful because the course of each disease may be different. Sarcoidosis is often mild, without lasting lung damage. Many patients with sarcoidosis have granulomas that disappear without treatment. More serious cases require the use of corticosteroids such as prednisone. On the other hand, chronic beryllium disease is incurable. Severe cases involve lung scarring and even strain on the right side of the heart due to increased pressure in the pulmonary artery from lung damage (cor pulmonale). Prednisone may also be used in treat chronic beryllium disease.

Taking a patient history is the first step in distinguishing chronic beryllium disease from sarcoidosis. On–the–job contact with beryllium points to chronic beryllium disease in a patient with the appropriate symptoms. However, today’s worker may not be aware of his or her beryllium exposure. Beryllium is used not only in spacecraft and electronics, but in a wide range of products that include bicycle frames, golf clubs, computers, jewelry, and dental alloys. Employees need to be informed when beryllium compounds or alloys are in use, as grinding, machining or polishing these alloys may release beryllium dust.

A blood test known as the BeLPT (beryllium lymphocyte proliferation test) provides an excellent way to diagnose chronic beryllium disease. The BeLPT measures how disease–fighting cells involved in immune responses, called lymphocytes, react to beryllium. If the lymphocytes react strongly, then the BeLPT is abnormal and indicates “beryllium sensitization,” an allergic reaction to beryllium. Beryllium sensitization often precedes the development of chronic beryllium disease, which may occur within three months and up to 30 to 40 years after initial beryllium exposure. The lymphocytes of sarcoidosis patients do not show any such abnormal reaction to beryllium. The article suggests that “…any ‘sarcoidosis’ patient who has worked around metal dust or fumes should be offered a BeLPT.”

Other means of diagnosing chronic beryllium disease include high–resolution computed tomography (HRCT) scans and pulmonary function tests. HRCT scans take a series of X–rays that are analyzed by computer to produce a cross section of the lungs. Pulmonary function tests indicate whether there are any abnormalities in lung volume, blood gas levels, and exercise capacity (Am Rev Respir Dis. 1993 Sep; 148(3): 661–6). Both HRCT scans and pulmonary function tests can show the presence and severity of respiratory disease, but they are not useful in distinguishing chronic beryllium disease from sarcoidosis.

Brayton Purcell is dedicated to upholding the legal rights of those with chronic beryllium disease. Since the late 1980s, we have represented beryllium workers as well as those who have come into contact with beryllium through others. Please feel free to contact us if you have developed chronic beryllium disease and wish to learn about your legal options.