Abstract
Chronic beryllium disease (CBD) is a granulomatous disease caused by exposure to beryllium, a metal with industrial applications. Although uncommon, CBD has the potential to cause end-stage lung disease. The effectiveness of lung transplantation (LT) in such patients is unknown and would benefit from reports of related cases.
The patient was a previously healthy 53-year-old man who first presented to our center in 2012 complaining of a few weeks of fatigue, dry cough, and unintentional weight loss after returning from an extended visit to India. History was relevant only for previous years-long employment at a factory producing golf clubs containing beryllium copper. Cardiac work-up was otherwise normal, but high-resolution computed tomography showed interstitial changes with ground-glass opacities and honeycombing. A blood beryllium lymphocyte proliferation test was abnormal. Pulmonary function testing was consistent with mild airflow limitation. Video-assisted thoracoscopic lung biopsy showed noncaseating granulomas eventually confirmed the diagnosis of CBD. The patient started methotrexate in 2013, which was well tolerated, but he experienced worsening dyspnea over the subsequent year. Objective measures worsened: increasing airflow limitation, decreasing six-minute walk distance, and up to four liters oxygen required with activity. He was evaluated for LT and listed in January 2015. He underwent bilateral LT in March 2015, without perioperative complications. The patient maintained stable pulmonary function without acute rejection or infectious complications through 2 years posttransplant. In 2018, the patient was admitted twice for viral pneumonia. In April 2019, he was diagnosed with bronchiolitis obliterans syndrome and started photopheresis in July. He was ultimately denied re-transplant in the ensuing years. The patient's most recent admission was April 2022 for hypercapnic respiratory failure. He opted for hospice care and died that month 63 years old.
Although LT for end-stage CBD is rare, its posttransplant course can reflect the mean in terms of allograft complications and survival. Single-center studies dedicated toward this population should be encouraged to better inform outcomes and expectations after LT.