A Cluster of Beryllium Sensitization Traced to the Presence of Beryllium in Concrete Dust

Abstract Background Chronic beryllium disease (CBD), a granulomatous disease with similarities to sarcoidosis, arises only in individuals exposed to beryllium. Inhaled beryllium can elicit a T-cell-dominated alveolitis leading non-necrotizing granulomata. CBD can be distinguished from sarcoidosis by demonstrating beryllium sensitization in a lymphocyte proliferation test. Research Question Beryllium exposure usually occurs in an occupational setting. Because of the diagnosis of CBD in a patient without evident beryllium exposure, we performed BeLPT among his work colleagues. Study Design and Methods This field study investigated a cohort of workmates without obvious beryllium-exposure. 21of 30 individuals were assessed in our outpatient clinic for beryllium sensitization. Therefore, BeLPT was performed with freshly collected peripheral blood mononuclear cells. Data were extracted from clinical charts, including geographical data. Beryllium content in dust samples collected at the workplace was measured by graphite-furnace atomic absorption spectroscopy and compared with samples from different areas of Germany. Results For the initial patient, the diagnosis of sarcoidosis was reclassified as CBD based on two positive BeLPT. Assessment of his work place did not identify a source of beryllium. However, BeLPTs performed for his workmates demonstrated beryllium sensitization in 5 out of 21 individuals, suggesting a local beryllium source. Concrete dust obtained from the building yard, the workplace of the index patient, contained high amounts of beryllium (1138±162 μg/kg), whereas dust from other localities (“control”) had much lower beryllium contents (ranging from 147±18 to 452±206 μg/kg). Notably, the control dusts from different places all over Germany exhibit different beryllium concentrations. Interpretation We describe a cluster of beryllium-sensitized workers from a non-beryllium-related industry caused by environmental exposure to beryllium-containing concrete dust, which exhibited markedly elevated beryllium content. Importantly, analyses of dusts from different localities contain markedly different amounts of beryllium. Thus, besides workplace-related exposure, environmental factors are also capable to elicit a beryllium sensitization.