During the next two weeks, the subject experienced increasing shortness of breath and was referred to the company physician. On examination, he reported bibasilar crackles. Chest x-ray film (Fig 1) showed bilateral lower lobe infiltrates and a diagnosis of chemical pneumonitis was made. The patient was advised to stay home, stay away from smoke, and avoid getting respiratory infections. Over the next three days, the shortness of breath and cough worsened, and the subject developed chest tightness. A second physician was consulted who arranged hospitalization. On admission, she was afebrile, had a respiratory rate of 20 per minute, heart rate of 90 beats per minute, and blood pressure of 110/70 mm Hg. A small degree of inflammation was noted in the posterior oropharynx. Crackles were heard over both lung bases and under the right clavicle.

The remainder of the physical examination was normal. Chest x-ray film revealed bilateral lower and right upper lobe pneumonitis. Pulmonary function test (PFT) results showed a restrictive pattern (Table 1). White blood cell count was 16,000/cu mm. Arterial blood gas values on room air were Po2, 84; C02, 28; and pH, 7.45. The ANA value was normal. A diagnosis of chemical pneumonitis was made, and therapy was instituted with oral prednisone, 40 mg daily. Her chest roentgenogram had partially cleared by March 12, and three days later, the patient was discharged on a two-week tapering regimen of prednisone. On March 30th, she returned to the emergency room complaining of “congestion in her chest and shortness of breath. These symptoms were attributed to a “severe flu syndrome.” A chest x-ray examination was not performed. this
On May 14th, the subject again experienced shortness of breath and cough, and a diagnosis of pneumonia was made. Chest x-ray film (Fig 2) showed partial resolution of the previously documented bilateral lower lobe densities and a new peripheral infiltrate. A concurrent urinary tract infection was also diagnosed. These problems were treated with oral ampicillin.
Table 1—Pulmonary Function Test Results

Date 3/2/86 6/24/86 9/30/86 12/16/86
FVC 2.10 2.69 2.23 2.49
% Predicted 70 90 75 84
FEV, 1.89 2.41 2.01 2.13
% Predicted 79 110 85 97
FEVj/FVC .90 .90 .90 .85
TLC* 3.15 4.38 3.52 3.43
% Predicted 64 93 72 69
FEF25-75 2.84 2.40 2.78 2.60
% Predicted 117 89 116 99
Deo, % Predicted 73 81 64 62

 

Figure 1. PA chest x-ray film—Feb 28, 1986.

Figure 1. PA chest x-ray film—Feb 28, 1986.

Figure 2. PA chest x-ray film—May 14, 1986.

Figure 2. PA chest x-ray film—May 14, 1986.