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may be preferable&#44; with modifiers as appropriate for etiology&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Application of strict diagnosis criteria and thorough etiological investigation may drastically reduce the number of idiopathic forms&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Considering the pulmonary effects of mineral exposure there are several papers on mining of gold mines&#44; all relating lung lesions with exposure to silica&#44; not gold&#46; So&#44; complication from gold dust exposure is a very hard to find thematic&#44; currently existing no references on Medline about this subject&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Clinical case description</span><p id="par0025" class="elsevierStylePara elsevierViewall">Male patient&#44; 47 years old&#44; sacred art restorer&#44; former smoker&#44; resorts to the Emergency room with three week evolution complaints of general malaise&#44; muscle pain&#44; persistent dry cough&#44; fever and weight loss of approximately 8<span class="elsevierStyleHsp" style=""></span>kg&#46; During the same period he started an exhaustive work of restoration of gilded altars&#44; exposing himself to a large amount of gold dust resulting from grinding and polishing the gold coating&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">On clinical evaluation there was hyperthermia &#40;38<span class="elsevierStyleHsp" style=""></span>&#176;C&#41;&#44; no dyspnoea&#44; hemodynamic stability&#44; mild hypoxemia &#40;SpO2 93&#37;&#41;&#44; and&#44; on auscultation&#44; there were sparse crackles in both lung bases&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Clinical analysis showed elevated Erythrocyte Sedimentation Rate &#40;94<span class="elsevierStyleHsp" style=""></span>mm&#41;&#44; elevated C-reactive Protein &#40;8&#44;02<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#41; and mild normocytic&#44; normochromic anemia &#40;11&#44;9<span class="elsevierStyleHsp" style=""></span>g&#47;dL&#41;&#46; Serology for infectious agents and research for autoantibodies were negative&#44; as was the search for acid-alcohol resistant bacilli&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">On chest x-ray there were clear interstitial nodular opacities at both bases&#44; more evident on the left side &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">The high-resolution chest CT scan revealed that &#8220;&#40;&#46;&#46;&#46;&#41; areas of parenchymal consolidation with air bronchograms in posterior-basal regions of both lungs and in the lingula&#44; strongly suggestive of pneumonic process &#40;&#8230;&#41;&#8221; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Lung function tests were also performed&#44; revealing mild restrictive pattern and normal CO diffusion&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Optic bronchoscopy with bronchoalveolar lavage revealed increased cellularity with lymphocytic dominance &#40;52&#37;&#41;&#44; and a low CD4&#47;CD8 ratio &#40;&#60;1&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">A transthoracic CT-guided biopsy was performed&#44; with 2 tissue samples being retrieved&#46; Histology revealed the existence of an organizational and exsudative intra-alveolar pneumonia process&#46; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">In light of the clinical history and clinical and laboratory findings the diagnosis of Organizing pneumonia induced by chemical agent aggression was assumed&#46; 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has clinical features of a flulike illness with cough&#44; fever&#44; malaise&#44; fatigue&#44; weight loss and inspiratory crackles frequently present on examination&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> These findings can be easily confused with a respiratory infection and lead to the administration of antibiotics&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">The differential diagnosis includes several clinical settings&#44; which may be associated with an OP pattern&#58; diffuse alveolar damage&#44; infection&#44; airways obstruction&#44; aspiration pneumonia&#44; drug reactions&#44; fume and toxic exposures&#44; collagen vascular disease&#44; hypersensitivity pneumonitis&#44; eosinophilic lung disease&#44; inflammatory bowel disease&#44; a secondary reaction in chronic bronchiolitis&#44; and a reparative reaction around other processes &#40;including abscesses&#44; Wegener&#39;s granulomatosis&#44; and neoplasms&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">To consider OP as cryptogenic&#44; first any cause or associated disorder must be ruled out&#46; So&#44; a thorough investigation must be made in order to establish a possible cause for OP&#46; In a recent case-series report from Barroso et al&#44; only 17&#37; of patients with an OP diagnosis presented a cryptogenic form&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">The clinical context&#44; time of the disease and radiologic findings&#44; selective serologic testing&#44; bronchoscopy &#40;including bronchoalveolar lavage&#41; and lung biopsy are important for diagnosis&#46; Correlation between histopathologic findings&#44; the clinical context and radiologic findings is essential&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">In the presented case&#44; the recent exposure to dust arising from the use of a gold microparticle polish product for the restoration of gilded altars became essential in guiding the etiological diagnosis&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Typical radiological changes were found either on Chest x-ray or high resolution Chest CT scan&#46; Pulmonary function tests&#44; although non-specific&#44; showed a restrictive pattern and hypoxemia&#44; also compatible with OP&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">The bronchoalveolar lavage &#40;BAL&#41; cytology was consistent with organizing pneumonia&#46; Although BAL cellular components may suggest a specific disease&#44; these findings are not diagnostic&#46; Unfortunately the delay between admission and the BAL execution did not allow for the identification of the causative gold microparticles&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Surgical lung biopsy is the standard for diagnosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1-6</span></a> It is the most effective method for confirming the diagnosis and assessing disease activity&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Biopsies from 2 separate sites are usually preferred&#44; but a generous specimen from a site that is representative of the underlying process may suffice&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> An accurate diagnosis is important because it identifies patients most likely to benefit from therapy&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">Recent studies also showed that CT-guided transthoracic lung biopsy &#40;a common procedure in our hospital&#41; may prove to be a reasonable alternative to more invasive procedures &#40;transbronchial and open surgical biopsies&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;8</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">The OP pattern is a patchy process characterized primarily by organizing pneumonia involving alveolar ducts and alveoli with or without bronchiolar intraluminal polyps&#44; and buds of loose connective tissue and inflammatory cells filling alveoli and distal bronchioles&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Case biopsy demonstrated an organizing pneumonia process&#46; Since other causes were ruled out&#44; the potential lung aggression from an inhaled chemical compound &#40;containing mineral gold&#41; was considered to be the etiological factor&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Glucocorticoid therapy - Prednisolone 1&#46;0 to 1&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;day - has good response and induces clinical remission within 4 weeks for two thirds<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> of patients&#46; At this time&#44; if response is good&#44; tapering is done to 0&#46;5 to 1&#46;0<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;day&#46; Therapy duration is around 6 months and prognosis is generally good&#44; with full recovery observed in 2&#47;3 of patients&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">This became a fact with our patient&#46; After 4 weeks of therapy full clinical remission and radiological improvement were noticed &#40;chest CT showed some remaining areas of ground glass&#41;&#46; Normal physical activities were also resumed&#46; Despite corticosteroid therapy&#44; eviction of the causative agent is mandatory&#44; in this case with the use of chemical protective masks&#46;</p></span></span>"
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        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A 47-year-old man&#44; restorer of religious art&#44; presents a three week history of asthenia&#44; myalgia&#44; dry cough and fever&#44; coinciding with recent&#44; unprotected exposure&#44; to golden dust&#46; He had fever&#44; crackles in lung bases&#44; hypoxemia and elevation of inflammatory markers&#46; Imaging studies showed areas of parenchymal consolidation with air bronchograms in posterior-basal regions of both lungs&#44; suggesting a pneumonic process&#46; Lung function tests&#58; mild restrictive pattern&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Bronchoalveolar lavage&#58; lymphocytosis with low CD4&#47;CD8 ratio&#46; Lung biopsy&#58; intraalveolar pneumonia with exsudative process and organization&#46; Treatment with Prednisolone 40<span class="elsevierStyleHsp" style=""></span>mg id was started with excellent response&#46; First month follow-up CT scan showed areas of ground glass suggesting residual pneumonitis&#44; and he resumed normal activities with excellent exercise tolerance&#44; under appropriate protection measures&#46;</p>"
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Case report
A rich and blessed professional illness - organizing pneumonia due to gold dust
P.A. Ribeiro
Corresponding author
pribeiromd@gmail.com

Corresponding author.
, F. Girão, P. Henriques
Serviço de Medicina Interna 1, Hospital de São Teotónio E.P.E., Viseu, Portugal
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Organizing pneumonia &#40;OP&#41; is an interstitial lung disease and a common nonspecific pathological response of the lung to injury&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Its idiopathic form is called Cryptogenic organizing pneumonia &#40;COP&#41;&#44; also being known as Idiopathic bronchiolitis obliterans organizing pneumonia &#40;or idiopathic BOOP&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> However the term cryptogenic organizing pneumonia &#40;COP&#41; is preferred because it conveys the essential features of the syndrome and avoids confusion with airway diseases such as constrictive bronchiolitis obliterans &#40;which can be problematic with the term BOOP&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The use of the generic term &#8220;organizing pneumonia&#8221; may be preferable&#44; with modifiers as appropriate for etiology&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Application of strict diagnosis criteria and thorough etiological investigation may drastically reduce the number of idiopathic forms&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Considering the pulmonary effects of mineral exposure there are several papers on mining of gold mines&#44; all relating lung lesions with exposure to silica&#44; not gold&#46; So&#44; complication from gold dust exposure is a very hard to find thematic&#44; currently existing no references on Medline about this subject&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Clinical case description</span><p id="par0025" class="elsevierStylePara elsevierViewall">Male patient&#44; 47 years old&#44; sacred art restorer&#44; former smoker&#44; resorts to the Emergency room with three week evolution complaints of general malaise&#44; muscle pain&#44; persistent dry cough&#44; fever and weight loss of approximately 8<span class="elsevierStyleHsp" style=""></span>kg&#46; During the same period he started an exhaustive work of restoration of gilded altars&#44; exposing himself to a large amount of gold dust resulting from grinding and polishing the gold coating&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">On clinical evaluation there was hyperthermia &#40;38<span class="elsevierStyleHsp" style=""></span>&#176;C&#41;&#44; no dyspnoea&#44; hemodynamic stability&#44; mild hypoxemia &#40;SpO2 93&#37;&#41;&#44; and&#44; on auscultation&#44; there were sparse crackles in both lung bases&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Clinical analysis showed elevated Erythrocyte Sedimentation Rate &#40;94<span class="elsevierStyleHsp" style=""></span>mm&#41;&#44; elevated C-reactive Protein &#40;8&#44;02<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#41; and mild normocytic&#44; normochromic anemia &#40;11&#44;9<span class="elsevierStyleHsp" style=""></span>g&#47;dL&#41;&#46; Serology for infectious agents and research for autoantibodies were negative&#44; as was the search for acid-alcohol resistant bacilli&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">On chest x-ray there were clear interstitial nodular opacities at both bases&#44; more evident on the left side &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">The high-resolution chest CT scan revealed that &#8220;&#40;&#46;&#46;&#46;&#41; areas of parenchymal consolidation with air bronchograms in posterior-basal regions of both lungs and in the lingula&#44; strongly suggestive of pneumonic process &#40;&#8230;&#41;&#8221; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Lung function tests were also performed&#44; revealing mild restrictive pattern and normal CO diffusion&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Optic bronchoscopy with bronchoalveolar lavage revealed increased cellularity with lymphocytic dominance &#40;52&#37;&#41;&#44; and a low CD4&#47;CD8 ratio &#40;&#60;1&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">A transthoracic CT-guided biopsy was performed&#44; with 2 tissue samples being retrieved&#46; Histology revealed the existence of an organizational and exsudative intra-alveolar pneumonia process&#46; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">In light of the clinical history and clinical and laboratory findings the diagnosis of Organizing pneumonia induced by chemical agent aggression was assumed&#46; The patient started treatment with prednisolone 40<span class="elsevierStyleHsp" style=""></span>mg id&#44; with immediate apyrexia and gradual respiratory function improvement&#46; Individual protection measures were also advised&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">After one month the patient comes for consultation asymptomatic&#46; The follow-up thoracic CT revealed images of ground glass opacity in the lung bases&#44; with no evidence of parenchymal consolidation &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>C&#41;&#44; which was quite an improvement&#46; At this time slow tapering of prednisolone &#40;5<span class="elsevierStyleHsp" style=""></span>mg &#47; month&#41; was started&#46; By the 3rd&#46; month of follow-up all normal physical activities had been resumed&#44; with no evidence of any changes on chest films or CT scan&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion and conclusion</span><p id="par0075" class="elsevierStylePara elsevierViewall">Organizing Pneumonia &#40;OP&#41; has clinical features of a flulike illness with cough&#44; fever&#44; malaise&#44; fatigue&#44; weight loss and inspiratory crackles frequently present on examination&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> These findings can be easily confused with a respiratory infection and lead to the administration of antibiotics&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">The differential diagnosis includes several clinical settings&#44; which may be associated with an OP pattern&#58; diffuse alveolar damage&#44; infection&#44; airways obstruction&#44; aspiration pneumonia&#44; drug reactions&#44; fume and toxic exposures&#44; collagen vascular disease&#44; hypersensitivity pneumonitis&#44; eosinophilic lung disease&#44; inflammatory bowel disease&#44; a secondary reaction in chronic bronchiolitis&#44; and a reparative reaction around other processes &#40;including abscesses&#44; Wegener&#39;s granulomatosis&#44; and neoplasms&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">To consider OP as cryptogenic&#44; first any cause or associated disorder must be ruled out&#46; So&#44; a thorough investigation must be made in order to establish a possible cause for OP&#46; In a recent case-series report from Barroso et al&#44; only 17&#37; of patients with an OP diagnosis presented a cryptogenic form&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">The clinical context&#44; time of the disease and radiologic findings&#44; selective serologic testing&#44; bronchoscopy &#40;including bronchoalveolar lavage&#41; and lung biopsy are important for diagnosis&#46; Correlation between histopathologic findings&#44; the clinical context and radiologic findings is essential&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">In the presented case&#44; the recent exposure to dust arising from the use of a gold microparticle polish product for the restoration of gilded altars became essential in guiding the etiological diagnosis&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Typical radiological changes were found either on Chest x-ray or high resolution Chest CT scan&#46; Pulmonary function tests&#44; although non-specific&#44; showed a restrictive pattern and hypoxemia&#44; also compatible with OP&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">The bronchoalveolar lavage &#40;BAL&#41; cytology was consistent with organizing pneumonia&#46; Although BAL cellular components may suggest a specific disease&#44; these findings are not diagnostic&#46; Unfortunately the delay between admission and the BAL execution did not allow for the identification of the causative gold microparticles&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Surgical lung biopsy is the standard for diagnosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1-6</span></a> It is the most effective method for confirming the diagnosis and assessing disease activity&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Biopsies from 2 separate sites are usually preferred&#44; but a generous specimen from a site that is representative of the underlying process may suffice&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> An accurate diagnosis is important because it identifies patients most likely to benefit from therapy&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">Recent studies also showed that CT-guided transthoracic lung biopsy &#40;a common procedure in our hospital&#41; may prove to be a reasonable alternative to more invasive procedures &#40;transbronchial and open surgical biopsies&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;8</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">The OP pattern is a patchy process characterized primarily by organizing pneumonia involving alveolar ducts and alveoli with or without bronchiolar intraluminal polyps&#44; and buds of loose connective tissue and inflammatory cells filling alveoli and distal bronchioles&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Case biopsy demonstrated an organizing pneumonia process&#46; Since other causes were ruled out&#44; the potential lung aggression from an inhaled chemical compound &#40;containing mineral gold&#41; was considered to be the etiological factor&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Glucocorticoid therapy - Prednisolone 1&#46;0 to 1&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;day - has good response and induces clinical remission within 4 weeks for two thirds<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> of patients&#46; At this time&#44; if response is good&#44; tapering is done to 0&#46;5 to 1&#46;0<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;day&#46; Therapy duration is around 6 months and prognosis is generally good&#44; with full recovery observed in 2&#47;3 of patients&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">This became a fact with our patient&#46; After 4 weeks of therapy full clinical remission and radiological improvement were noticed &#40;chest CT showed some remaining areas of ground glass&#41;&#46; Normal physical activities were also resumed&#46; Despite corticosteroid therapy&#44; eviction of the causative agent is mandatory&#44; in this case with the use of chemical protective masks&#46;</p></span></span>"
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            0 => "Cryptogenic Organizing Pneumonia"
            1 => "Pneumoconiosis"
            2 => "Gold"
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            0 => "Pneumonia organizativa criptog&#233;nica"
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        "titulo" => "Abstract"
        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A 47-year-old man&#44; restorer of religious art&#44; presents a three week history of asthenia&#44; myalgia&#44; dry cough and fever&#44; coinciding with recent&#44; unprotected exposure&#44; to golden dust&#46; He had fever&#44; crackles in lung bases&#44; hypoxemia and elevation of inflammatory markers&#46; Imaging studies showed areas of parenchymal consolidation with air bronchograms in posterior-basal regions of both lungs&#44; suggesting a pneumonic process&#46; Lung function tests&#58; mild restrictive pattern&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Bronchoalveolar lavage&#58; lymphocytosis with low CD4&#47;CD8 ratio&#46; Lung biopsy&#58; intraalveolar pneumonia with exsudative process and organization&#46; Treatment with Prednisolone 40<span class="elsevierStyleHsp" style=""></span>mg id was started with excellent response&#46; First month follow-up CT scan showed areas of ground glass suggesting residual pneumonitis&#44; and he resumed normal activities with excellent exercise tolerance&#44; under appropriate protection measures&#46;</p>"
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      "es" => array:2 [
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        "resumen" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Homem de 47 anos de idade&#44; restaurador de arte sacra&#44; apresenta hist&#243;ria com 3 semanas de evolu&#231;&#227;o de astenia&#44; mialgias&#44; tosse seca e febre&#44; coincidindo com exposi&#231;&#227;o recente e n&#227;o protegida a poeiras de ouro&#46; Encontrava-se febril&#44; com crepita&#231;&#245;es inspirat&#243;rias nas bases pulmonares&#44; hipox&#233;mia e eleva&#231;&#227;o dos marcadores inflamat&#243;rios&#46; Radiologicamente&#58; &#225;reas de consolida&#231;&#227;o parenquimatosa com broncogramas a&#233;reos postero-basais bilateralmente&#44; sugerindo processo pneum&#243;nico&#46; Provas funcionais respirat&#243;rias&#58; padr&#227;o restritivo ligeiro&#46; Lavado bronco-alveolar&#58; linfocitose&#44; baixo &#237;ndice CD4&#47;CD8&#46; Bi&#243;psia pulmonar&#58; pneumonia alveolar com processo exsudativo e organizativo&#46; Iniciou terap&#234;utica com prednisolona 40<span class="elsevierStyleHsp" style=""></span>mg id com excelente resposta&#46; TAC de controlo &#40;1 m&#234;s&#41;&#58; &#225;reas de vidro-despolido sugerindo pneumonite residual&#46; O doente retomou as suas actividades normais com excelente toler&#226;ncia ao exerc&#237;cio&#44; sob medidas de protec&#231;&#227;o adequadas&#46;</p>"
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        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara">Please cite this article as&#58; Ribeiro PA&#44; et al&#46; Uma doen&#231;a professional valiosa e aben&#231;oada &#8212; pneumonia organizativa devido a poeira de ouro&#46; Rev Port Pneumol&#46; 2011&#59; 17&#58; 182&#8211;185&#46;</p>"
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          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Image 1A - Chest x-ray&#58; interstitial nodular opacities at both bases&#44; but more evident on the left side &#40;arrow&#41;&#46; Image 1B - High resolution CT scan&#58; bilateral areas of parenchymal consolidation with air bronchograms in posterior-basal regions and the lingula strongly suggesting a pneumonic process&#46; Image 1C - ground glass opacity in the lung bases and no evidence of parenchymal consolidation &#40;1 month follow-up&#41;&#46;</p>"
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          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Lung histology &#40;A &#8211; H&#38;E&#44; B &#8211; Cytokeratin&#41;&#58; diffuse parenchymal lung changes&#59; marked enlargement of the alveolar septa&#44; foci of edema and mild to moderate lymphocytic infiltrate with rare neutrophils and some eosinophils&#46; Frequent intra-alveolar myofibroblast proliferation with small nodules present&#46; These are partially coated with highly reactive pneumocytes&#46; No granulomas&#44; vascular thrombi or neoplastic proliferation are identified&#46; These aspects are indicative of a process of organizational and exsudative interstitial pneumonia&#46;</p>"
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                  "host" => array:1 [
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            3 => array:3 [
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Article information
ISSN: 21735115
Original language: English
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