Chronic beryllium disease: Don't miss the diagnosis

Chronic beryllium disease is an increasingly common granulomatous disorder often mistaken for sarcoidosis. Patients may present with a variety of respiratory and systemic symptoms, such as nonproductive cough, fatigue, dyspnea, weight loss, and fever. The earliest clinical signs are scattered bibasilar crackles and wheezing. Ulceration or subcutaneous tender nodules may be seen if beryllium penetrates the skin. There is no characteristic pattern of pulmonary function abnormalities, and the radiologic presentation is similar to that of sarcoidosis. A high degree of clinical suspicion must be maintained when evaluating patients with a history of direct or indirect exposure to beryllium or metal alloys. Diagnosis relies on evidence of lung inflammation and beryllium sensitization. Corticosteroid treatment is usually given to symptomatic patients who demonstrate a decline in lung function.