Beryllium disease and sarcoidosis: still besties after all these years?

Toxic pulmonary disease from beryllium exposure first came to light in the 1930s, soon after the emergence of industrial uses of beryllium alloys. An early manufacturing application for beryllium compounds, as phosphors in fluorescent tubes, was the cause of some of the first known cases of chronic beryllium disease (CBD) (first termed “pulmonary granulomatosis of beryllium workers”). However, the association between beryllium and granulomatous inflammation was controversial at the outset, leading to the moniker “Salem sarcoid” to describe the outbreak of “sarcoidosis” among fluorescent bulb workers at a manufacturing plant in Salem, MA, USA [1]. Despite opposition from the manufacturer and its allies in the state government, H. Hardy convincingly established the relationship between beryllium exposure and granulomatous disease with her landmark analysis of 17 workers from the Salem light bulb factory [2]. Her key insight was to identify the high frequency of latency of disease onset and progression after cessation of exposure. Nearly a century later, despite subtle clinical and radiological differences, the salient features of pulmonary sarcoidosis and CBD continue to be nearly indistinguishable, leading to occasional suggestions that CBD may be simply “sarcoidosis of known cause” [3].