Interstitial pneumonia following exposure to fluorocarbon polymers

Perfluoroalkyl resins are compounds containing hydrophobic alkyl chains, which are partially or fully fluorinated. These resins are heat-resistant (up to 260°C) thermoplastics used as coatings in the metallurgical industry (because of their mechanical and anti-adhesive resistance), as waterproofing agents for coating fabric, in papers used in the food industry, and in surface-active products, waxes, and insecticide formulations. As waterproofing agents, these resins are applied by manually-compressed or motorized spraying systems or by sprays. Reports of respiratory symptoms or epidemics in countries in Europe, Asia, and North America, totaling a few hundred cases, are summarized in a 2009 document by the Public Health Agency of Switzerland. The cases include patients with varying degrees of clinical impairment. We report the first case of interstitial pneumonia caused by exposure to fluorocarbon resins in Brazil. A 21-year-old male nonsmoker with interstitial pneumonia and no history of respiratory disease was evaluated at our facility. One year earlier, the patient was employed at a furniture factory specializing in the manufacture of sofas and armchairs. He worked as a sofa assembler for three months. Subsequently, he was transferred to an adjacent room, where he filled cushions with synthetic flakes and foams. In that same room, a coworker performed the waterproofing of the fabrics by using a manually-compressed spraying system (Figure 1). The work area was a rectangular enclosure of 30 m 2 , with no ventilation/ exhaust system, where there were waterproofing product mists. One week later, he had flu-like symptoms that resolved with withdrawal from the workplace. When he returned to work, he developed progressive dyspnea and cough, followed by limitation of physical activities, such as playing soccer and climbing stairs. One month later, he sought treatment from a cardiologist, who started clinical investigation. He continued to work, and the symptoms gradually worsened. Three months later, he had sudden pain in the left hemithorax with worsening dyspnea, a pneumothorax was diagnosed, and there was a finding of diffuse ground-glass infiltration (Figure 2A). Twelve days later, drainage resulted in unsatisfactory lung expansion, and the patient underwent thoracotomy and lung biopsy, which revealed desquamative interstitial pneumonia (Figures 2B and 2C). One month later, he was asymptomatic. A follow-up CT scan showed apical and subpleural bullae and a band in the left hemithorax, which was associated with the area of previous surgical manipulation. His alpha-1-antitrypsin level was normal (183 mg/dL). The patient was started on a 45-day course of …