Pulmonary Alveolar Proteinosis in Workers at an Indium Processing Facility

Abstract

Two cases of pulmonary alveolar proteinosis, including one death, occurred in workers at a facility producing indium-tin oxide (ITO), a compound used in recent years to make flat panel displays. Both workers were exposed to airborne ITO dust and had indium in lung tissue specimens. One worker was tested for autoantibodies to granulocytemacrophage-colonystimulating factor (GM-CSF) and found to have an elevated level. These cases suggest that inhalational exposure to ITO causes pulmonary alveolar proteinosis, which may occur via an autoimmune mechanism.

Indium lung—case reports and epidemiology

“…In 2010, Cummings et al (2010) reported 2 cases of PAP in an indium-processing facility in the United States. The Wrst of these two cases (Case 8) was a 49-year-old nonsmoker and began working in 1999.…”

Pulmonary Alveolar Proteinosis and Tracheal Stenosis After Exposure to Fire and Fire Extinghuisher

“…In the BAL or serum, anti-GM-CSF antibody measurement is useful for secondary PAP diagnosis and levels of anti-GM-CSF antibodies correlated with the severity of PAP (11). In one patient with PAP related to indium-tin oxide exposure, elevated levels of antibodies to GM-CSF were noted (12). In the present case, secondary PAP was thought for exposure to fire and fire extinguishers.…”

Relationship between indium exposure and oxidative damage in workers in indium tin oxide production plants

“…There are two cases of pulmonary alveolar proteinosis, a rare disease, which have been reported in workers involved in the production and recycling of ITO (Cummings et al 2010). Pulmonary alveolar proteinosis forms via intraalveolar accumulation of surfactant, as a result of impaired gas exchange.…”

“…Since 1998, studies have revealed that interstitial pneumonia and pulmonary fibrosis occurred in workers exposed to ITO (Homma et al 2003(Homma et al , 2005. Several recent occupational epidemiological studies continuously mentioned adverse health effects resulting from insoluble indium, including lung abnormalities (Cummings et al 2010;Homma et al 2003Homma et al , 2005Taguchi and Chonan 2006). The first case of interstitial pneumonia was found with inhaling ITO particles (Homma et al 2003).…”

“…Similar results were found by Hamaguchi et al (2008) in workers at ITO production and recycling plants. In 2010, it was reported that two workers developed pulmonary alveolar proteinosis, identified by histopathological section, due to ITO exposure of an indium-processing facility (Cummings et al 2010). Meanwhile, serum surfactant protein D (SP-D) has been shown to have a close relationship with S-In exposure (Hamaguchi et al 2008).…”