PMID: 15228137Jul 2, 2004Paper

A case of hypersensitivity pneumonitis showing acute respiratory distress syndrome due to exposure to dust containing diphenylmethane diisocyanate

Nihon Kokyūki Gakkai zasshi = the journal of the Japanese Respiratory Society
Yoshitaka MorimatsuHisamichi Aizawa

Abstract

The patient was a 61-year-old man who reported coughing and fever that occurred immediately after the work of breaking up a large refrigerator containing diphenylmethane diisocyanate (MDI). He was brought to our medical center with respiratory distress ten days after onset. Acute respiratory distress syndrome was diagnosed on the basis of a P/F oxygen ratio of less than 200 and chest CT findings of extended consolidation in both lung fields. He was intubated and ventilated mechanically. Steroid pulse therapy was started because of an elevated lymphocyte count found through bronchoalveolar lavage (BAL). After that, arterial blood gas and chest radiography findings improved gradually, and high-resolution chest findings on the 4th day of hospitalization showed centrilobular and uncleared shadows of marginated acini in both lung fields. The patient was extubated ten days after admission, the steroid therapy was withdrawn, and he was discharged from the intensive care unit on the 22nd day of hospitalization. Transbronchial lung biopsy on admission revealed alveolitis, Masson bodies and activated macrophages in the air spaces. The dismantled refrigerator was known to contain MDI, and because of the IgE and the IgG to MDI present in t...Continue Reading

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