Glutaraldehyde is commonly used in endoscopy labs to clean and disinfect instruments. It can cause direct irritation of the skin and the upper and lower airways. Health care workers are also at risk for the development of irritant-induced or sensitizer-induced occupational asthma when exposed to this chemical. Herein, we report on a patient who had frequent exposures to glutaraldehyde over one year while working in an endoscopy lab and developed chronic upper and lower respiratory tract symptoms. Multiple spirometric tests during her evaluation revealed variable results including restrictive pattern with a response to bronchodilators, obstructive pattern with a paradoxic bronchoconstrictive response to bronchodilators, and obstructive pattern with a partial response to bronchodilators. These results indicate that the distribution of inflammation and bronchial responsiveness can vary in a single patient with glutaraldehyde-induced occupational asthma. Therefore, the evaluation may be more difficult than might be expected in patients with occupational asthma, and some patients will need multiple pulmonary function tests to characterize their airway disease.
CaseThis patient presented to the emergency center with two days of fever, dyspnea, and productive cough. His chest radiographs and computed tomography scans showed significant abnormalities in the right thorax (Figures 1 and 2). He recalled having some type of surgery in Mexico as a child for tuberculosis. Since this surgery, he has lived a productive life and denied chronic respiratory limitations. He denied recurrent tuberculosis. The patient was admitted to the hospital; he decompensated and required intubation with mechanical ventilation. Bronchoscopy was performed to evaluate his right lung. The RUL orifice was noted, but the bronchoscope was unable to be passed into it. The RML bronchus was open but severely constricted. The bronchoscope was unable to be passed into this bronchus as well. The RLL
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