Abstract

A 64-year-old man who was an exercise physiologist was noted to have clinical and physiological features of idiopathic pulmonary fibrosis.1 On detailed questioning, he stated that he had ground, machined, drilled, and sanded Corian (a solid-surface material composed of acrylic polymer and aluminum trihydrate2) in his garage for about 16 years. He had typical clinical features of idiopathic pulmonary fibrosis and radiographic features of usual interstitial pneumonia, and a surgical lung biopsy showed histologic features of usual interstitial pneumonia a hallmark of idiopathic pulmonary fibrosis. Prompted by an elicited history of exposure and findings on polarized light microscopy, we conducted further tissue analyses that showed aluminum trihydroxide in the fibrotic lung; this finding provided support for a potential causal relationship between the Corian dust and pulmonary fibrosis. Although the patient avoided further exposure to Corian dust, his respiratory status slowly deteriorated over the next 7 years and he died from respiratory failure secondary to pulmonary fibrosis. High-resolution computed tomographic images of the chest showed an overall pattern that was consistent with end-stage usual interstitial pneumonia. At autopsy, the lungs were small; aluminum trihydroxide was detected in the fibrotic lungs.

Although the evidence from this single case is circumstantial, the history of exposure, analyses of the lung tissue, and the sample of dust obtained from the patient's environment are consistent with a causal association. Pulmonary fibrosis has been associated with metal dusts and aluminum.3,4 A meta-analysis of six case–control studies of idiopathic pulmonary fibrosis showed a significant association between metal exposures and this condition.5 Without the elicited history of exposure to Corian dust and the finding of birefringent particles in the tissue, we would not have considered Corian dust as a potential cause of pulmonary fibrosis and the patient would have been considered to have idiopathic pulmonary fibrosis.1 Although the findings from this case do not confirm causality, until further data to support or refute the association are available, inquiry into each patient's occupational and environmental exposures should be made when considering a diagnosis of idiopathic pulmonary fibrosis.

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