Glass Microparticulate Ingestion: An Unusual and Difficult to Diagnose Cause of Chronic Abdominal Pain

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Purpose: Occupational particulate inhalation causing injury in an organ other than the lung is rare. Here we report a case of glass microparticulate ingestion causing chronic abdominal pain and pathology associated with altered local and systemic inflammatory responses. Clinical Vignette: The patient is a previously healthy 38 yo man who developed chronic recurrent abdominal pain after starting work as a manager at a glass-cutting factory. Physical exam was unremarkable both during and between pain episodes. Initial evaluation was notable for leukocytosis and elevated C-reactive protein, but normal basic metabolic profile, liver function tests and cultures. Testing for porphyrins, heavy metals, and angioedema was negative. EGD, colonoscopy, and capsule endoscopy were non-diagnostic. Abdominal CT during a pain flare showed mild thickening in the appendix and mesenteric stranding with subcentimeter mesenteric lymph nodes. This led to diagnostic laparoscopy. Mesenteric lymph node biopsies showed chronic inflammation with evidence of foreign body reaction. X-ray microanalysis revealed the presence of silicon, silver chloride, tungsten, titanium and vanadium, metals commonly used in the manufacture of glass (Figure). We performed immunohistochemistry for IL-1β because it is important for granuloma formation. The patient exhibited significantly less IL-1β staining than positive controls with granulomatous tissue (sarcoidosis and hypersensitivity allergic alveolitis), consistent with reports of silica-induced inhibition of proinflammatory cytokines. Moreover, lipopolysaccharide-induced IL-1β protein secretion in whole blood cells was significantly lowered in the patient compared to healthy controls (Figure). On clinical follow-up, exposure avoidance with a respirator mask at work led to a significant symptom improvement. Conclusions: Inadvertent glass microparticulate ingestion and probable microperforation led to a silica-induced impairment of IL-1β secretion and chronic inflammation/pain. Exposure avoidance resulted in clinical improvement. Occupational exposures should be considered in patients with unexplained chronic GI complaints.Figure: [685]