Hard Metal Lung Disease: A case of an under recognised metallic malady

<bold>Introduction:</bold> Hard Metal Lung Disease (HMLD) is a form of Interstitial Lung Disease (ILD) that occurs due to occupational exposure to sintered tungsten carbide and cobalt which are widely used in industry. <bold>Case Report:</bold> A 49 year old woman presented with Dry cough & progressive breathlessness of 10 months duration. She was a homemaker with no significant personal, past and family histoty. Clinical examination was normal. Imaging showed bilateral lung perilymphatic nodules with interlobular septal thickening and enlarged mediastinal lymphnodes. Bronchoscopy with TBNA and TBLB showed Giant cell interstitial pneumonia suggestive of HMLD. The history was revisited and it transpired that she lived in an industrial town in South India called Bellary where many granite factories and mines are there. Tungsten is a component commonly found in granite mines and is one of the component of Hard metal. Patient was removed from the exposure and started on a weaning course of oral steroids along with pulmonary rehabilitation & vaccination. Review after 3 months showed significant improvement in symptoms, lung functions and imaging. <bold>Discussion:</bold> HMLD is a rare cause of ILD. It is characterised by presence of characteristic Giant cells. This case is important as it highlights the importance of non occupational exposure. Our patient hailed from the industrial town of Bellary. Bellary has in fact been featured in mainstream media recently as having a surge in respiratory illnesses which has been attributed to the rapid rise in industrialization of the area. <bold>Conclusion:</bold> An unexplained ILD from a resident of an industrial town should prompt the possibility of HMLD in addition to other conditions such as silicosis or pneumoconiosis.