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Grand Rounds
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| Silica Exposure and Systemic Vasculitis Karen B. Mulloy Program in Occupational and Environmental Health, Department of Internal Medicine, University of New Mexico Health Sciences Center, University of New Mexico, Albuquerque, New Mexico, USA Abstract
  University of New Mexico Health Sciences Center Work in Department of Energy (DOE) facilities has exposed workers to multiple toxic agents leading to acute and chronic diseases. Many exposures were common to numerous work sites. Exposure to crystalline silica was primarily restricted to a few facilities. I present the case of a 63-year-old male who worked in DOE facilities for 30 years as a weapons testing technician. In addition to silica, other workplace exposures included beryllium, various solvents and heavy metals, depleted uranium, and ionizing radiation. In 1989 a painful macular skin lesion was biopsied and diagnosed as leukocytoclastic vasculitis. By 1992 he developed gross hematuria and dyspnea. Blood laboratory results revealed a serum creatinine concentration of 2.1 mg/dL, ethrythrocyte sedimentation rate of 61 mm/hr, negative cANCA (antineutrophil cytoplasmic antibody cytoplasmic pattern) , positive pANCA (ANCA perinuclear pattern) , and antiglomerular basement membrane negative. Renal biopsy showed proliferative (crescentric) and necrotizing glomerulonephritis. The patient's diagnoses included microscopic polyangiitis, systemic necrotizing vasculitis, leukocytoclastic vasculitis, and glomerulonephritis. Environmental triggers are thought to play a role in the development of an idiopathic expression of systemic autoimmune disease. Crystalline silica exposure has been linked to rheumatoid arthritis, scleroderma, systemic lupus erythematosus, rapidly progressive glomerulonephritis and some of the small vessel vasculitides. DOE workers are currently able to apply for compensation under the federal Energy Employees Occupational Illness Compensation Program (EEOICP) . However, the only diseases covered by EEOICP are cancers related to radiation exposure, chronic beryllium disease, and chronic silicosis. Key words: crystalline silica, Department of Energy workers, Energy Employees Occupational Illness Compensation Program, Nevada test site, systemic vasculitis. Environ Health Perspect 111:1933-1938 (2003) . doi:10.1289/ehp.6400 available via http://dx.doi.org/ [Online 6 October 2003]
Address correspondence to K.B. Mulloy, Program in Occupational and Environmental Health, Department of Internal Medicine, MSC10 5550, 1 University of New Mexico, Albuquerque, NM 87131-0001 USA. Telephone: (505) 272-4027. Fax: (505) 272-5958. E-mail: kmulloy@salud.unm.edu The author declares she has no competing financial interests. Received 21 April 2003 ; accepted 6 October 2003.
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