Berilliosis (beryllium poisoning): causes, symptoms, diagnosis and treatment

By Cristiano Antonino On Apr 17, 2023

Berylliosis is a type of pneumoconiosis, i.e. a lung disease caused by inhalation of dust, e.g. at work, and in fact berylliosis is a typical occupational respiratory disease

It is a systemic granulomatous disease with pulmonary manifestations, caused by inhalation of dust or fumes containing beryllium compounds or products.

It is also called beryllium disease, beryllium poisoning or beryllium granulomatosis.

Causes of beryllium disease

Exposure to beryllium used to be common in many industries, including beryllium mining, electronics industries, chemical plants and fluorescent lamp factories.

Today, its main use is in the aerospace industry.

Berylliosis differs from most other pneumoconioses: it appears to be a hypersensitivity disease and occurs in only about 2% of exposed individuals.

Symptoms may occur acutely or may not appear until 10-20 years after exposure, which may have been brief.

Pathological anatomy and pathophysiology

Acute berylliosis is a chemical pneumonitis, but may also affect other organs (e.g. skin and conjunctiva).

The anatomo-pathological changes in the lung are represented by diffuse inflammatory infiltrates in the parenchyma and non-specific intraalveolar oedema.

The anatomo-pathological feature of chronic berylliosis is a diffuse granulomatous reaction of the lungs and hilar lymph nodes, which is histologically indistinguishable from sarcoidosis.

Early formation of a granuloma with mononuclear cells and giant cells can also be observed.

Symptoms, signs and diagnosis of berylliosis

Patients with acute berylliosis often present with dyspnoea, coughing, weight loss and highly variable x-ray pictures, which usually demonstrate diffuse alveolar thickening.

This disease is extremely rare in North America.

Patients with chronic forms complain of insidious and progressive exertional dyspnoea, cough, chest pain, weight loss and asthenia.

Symptoms may not manifest themselves until 20 years after exposure has ceased.

Chest X-ray shows signs of diffuse infiltration, often with hilar adenopathy, reminiscent of the sarcoidosis picture.

Pictures of milar diffusion are also observed.

Diagnosis is based on anamnestic data of exposure and typical clinical manifestations.

However, unless special immunological techniques are used, it is often impossible to differentiate berylliosis from sarcoidosis.

Prognosis, prophylaxis and therapy for berylliosis

The acute form can be fatal, but patients who survive have an excellent prognosis.

Clinical manifestations in those who survive are usually short-lived and completely reversible.

The chronic form often results in a progressive reduction in respiratory function.

It can lead to right ventricular overload, with death from pulmonary heart disease.

The elimination of industrial dust forms the basis of beryllium exposure prevention, but its effectiveness is not absolute.

The disease (both acute and chronic) must be recognised promptly and affected workers must be removed from further exposure to beryllium.

Treatment of acute beryliosis is generally symptomatic.

The lungs often become oedematous and haemorrhagic and mechanical ventilation is necessary in severely affected patients.

In symptomatic patients with pulmonary function abnormalities, prednisone 60 mg/day PO or the EV equivalent should be administered for a period of 2-3 weeks, with scaling down of the dosage in the following 3-4 weeks to 10-15 mg/day.

Although corticosteroids have been used in chronic berylliosis, the response is usually unsatisfactory.

A marked, prolonged improvement probably indicates that the patient is suffering from sarcoidosis rather than berylliosis.