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This is a case report on a 66-year old woman who suffered from chronic polyarthritis for 15 years and developed a sicca syndrome pattern for 2 years. 2 years later epithelioid cell granulomas were found from a submandibular lymph node as well as from a suspicious area at the epiglottis and the mucosa of the upper lip. Moreover, there was a chronic keratoconjunctivitis and discrete lung involvement. The sarcoidosis on the lip and at the epiglottis disappeared, and lung involvement and conjunctivitis improved under corticosteroid therapy. In spite of above therapy, the sicca syndrome pattern and the rheumatic complaints (osteoporosis) persisted.

The extent of the pulmonary reaction to intensive exposure to dust is influenced by a number of factors, in particular the nature of the fibre, morphometry, solubility, duration of dust exposure, dust concentration, and, finally, the manufacturing process of the MMMF product and its chemical composition. The biological effect of the fibres on the lung is manifest by enhanced infiltration by macrophages and an increase in the number of neutrophils. In agreement with numerous published results, our own investigations failed to reveal any signs of a fibrogenic effect of MMMF. The reason for this is presumably the lack of biostability, the tendency of the fibres to fracture crosswise, and the much lower concentration of fibres in the critical length-diameter range. In contrast, MMMF have been shown to induce an irritation of the mucosa and the upper airways. With respect to possible long-term damage produced by MMMF from our own production, we have had no such experience to date.

In 860 patients 980 bronchoalveolar lavages were performed. The repeated BAL allows conclusions of the effect of treatment and the prognosis of the disease. BAL is together with other clinical findings an important new method in pulmology. Its value in diagnosis of interstitial pulmonary diseases and other pulmonary diseases is described with special view to occupational expositions.