For the daughter, initial evaluation includes a careful history, thorough physical examination, and a chest X-ray. The history suggests an infectious process and, given the clinical picture, no other laboratory tests are recommended at this time. If her respiratory symptoms become chronic, she should be reevaluated. Asthma should be considered and, if her revaluation suggests an interstitial lung disease, the blood beryllium-stimulated lymphocyte transformation test may be used for screening.
Due to proven beryllium exposure, the father is a candidate for a more complete evaluation for beryllium toxicity. An abnormal blood beryllium-stimulated lymphocyte transformation test would indicate an increased probability that both the cutaneous and pulmonary abnormalities are due to beryllium exposure. A negative blood test, however, would not exclude the diagnosis of chronic beryllium disease. If the blood test is negative, consideration should be given to a bronchoscopy for lung tissue biopsy and bronchoalveolar lavage lymphocyte transformation test. (Note: The presence of macrophages in the lavage specimen of smokers can render the lavage test inconclusive.)
The treatment for bronchitis is supportive care and should include rest, air humidification, and avoidance of noxious stimuli such as cigarette smoke. Antibiotics should be used if bacterial bronchitis is strongly suggested by the clinical course or is proven by reliable laboratory techniques. Given the sleep disturbance experienced by this patient, consideration may be given to bronchodilator therapy such as an inhaled β2 agonist. If the patient’s clinical course suggests asthma, treatment should be tailored to her needs.
The father has chronic beryllium disease and a beryllium-induced skin ulceration. The first therapeutic effort should be to remove him from further exposure to beryllium. Values should be obtained for the following baseline tests: pulmonary function tests, carbon monoxide diffusion, and arterial blood gases. Corticosteroid therapy should be instituted.
The father should be reevaluated periodically to assess whether he has responded to corticosteroids, and to taper the dose to the minimum needed to control symptoms and maintain physiologic improvement. He should also be monitored for potential long-term steroid side effects. Excision of the cutaneous lesion should prove curative for the skin condition, but lifelong corticosteroid therapy will most likely be required for the lung condition.
Because the father may represent a sentinel case, the local health department should be notified. To prevent further exposures, the patient’s workplace should be evaluated. Notification of OSHA or a request for a NIOSH health hazard survey may be warranted.
More information on the adverse effects of beryllium and treating and managing cases of exposure to beryllium can be obtained from ATSDR, your state and local health departments, and university medical centers. Case Studies in Environmental Medicine: Beryllium Toxicity is one of a series. For other publications in this series, please use the order form on the back cover. For clinical inquiries, contact ATSDR, Division of Health Education, Office of the Director, at (404) 639–6204.