A57-14 A Bery Tricky Nodule

Abstract Introduction Berylliosis is an acquired type IV hypersensitivity reaction to beryllium that causes granulomatous interstitial lung disease. Here, we describe a patient who underwent bilateral lung transplant (LT) for severe chronic obstructive pulmonary disease (COPD) who was also found to have berylliosis. Case Presentation A 55-year-old man with a 33-pack-year smoking history and COPD presented for consideration of LT for severe COPD. His pulmonary function test (PFT) at the time showed a forced expiratory volume in one second (FEV1) of 17% with a diffusing capacity of 22%. He required 6L oxygen per minute. Imaging was notable for severe centrilobular emphysema with extensive pulmonary scarring, innumerable pulmonary nodules, and mild bronchiectasis. Given the history of smoking, a PET CT was obtained and showed enlarged mediastinal, hilar, and bronchial lymph nodes. Biopsies were obtained and showed poorly formed granulomata with cultures negative for infection. The patient continued his evaluation for LT. One year later, the patient was nearing listing for LT. He required 8L oxygen per minute. The patient was found to have an enlarging right upper lobe (RUL) nodule. A repeat PET CT showed a hypermetabolic RUL mass-like consolidation with FDG-avid mediastinal lymph nodes. Biopsy of the mass showed poorly formed granulomata. Serologic testing for fungal and mycobacterial infections was again negative. The patient was then listed for transplant and underwent a bilateral LT. In addition to severe emphysema, his explant showed diffuse bilateral pulmonary granulomatous disease and lymph nodes with non-necrotizing granulomas in a pattern suggestive of berylliosis. It became apparent that the patient had previously worked at a foundry shop where he melted 24,000 pounds of beryllium a month for 25 years. The patient is recovering well with improvement in both his symptoms and his PFTs, with FEV1% of 92%. Discussion Berylliosis is a form of pneumoconiosis that results from prolonged exposure to inhaled beryllium. Studies have reported incidence rates of up to 10% in patients with high-risk occupations. Susceptible individuals develop beryllium sensitization due to a type IV reaction, which can progress to berylliosis even years after last exposure. The clinical course can be variable. Here, we describe a case of concomitant COPD and berylliosis. While our patient’s COPD alone was severe enough to warrant transplant, the diffuse nature of his berylliosis likely also contributed to disease severity. Additionally, the patient’s time to listing was delayed by repeat biopsy of findings ultimately attributable to beryllium. This abstract is funded by: None