Occupational interstitial lung disease requiring living-donor lung transplantation: multielement deposition in explanted lungs

We report a man in his 40s with progressive interstitial lung disease following long-term occupational exposure to industrial waste dust. Despite corticosteroid therapy, his respiratory condition deteriorated, with acute exacerbation requiring repeated high-dose steroid pulse therapy and additional immunosuppressive treatment. He subsequently underwent bilateral living-donor lung transplantation. Histopathological examination of the explanted lungs demonstrated unclassifiable interstitial pneumonia characterised by fibrotic non-specific interstitial pneumonia-like changes, surfactant accumulation and pleuroparenchymal fibroelastosis. Elemental analysis using wavelength-dispersive electron probe microanalysis revealed a wide range of inorganic elements, including aluminium, iron, silicon, nickel, manganese, cobalt and rare earth elements such as cerium and lanthanum. These findings strongly suggest that chronic inhalation of heterogeneous occupational particulates contributed to disease pathogenesis. The patient remains clinically stable 4 years after transplantation, with good functional recovery.