Chronic Beryllium Disease Mimicking Hypersensitivity Pneumonitis Leading to Lung Transplantation: A Diagnostic Challenge

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Abstract
Chronic beryllium disease (CBD) is a granulomatous lung disease caused by immune sensitization to beryllium and may closely mimic other interstitial lung diseases (ILDs), including hypersensitivity pneumonitis (HP) and sarcoidosis. We present a case of a woman in her 60s with progressive restrictive lung disease initially diagnosed as HP who ultimately required lung transplantation after years of clinical decline. Subsequent review of her occupational and environmental history revealed potential beryllium exposure. Explant pathology demonstrated non-necrotizing granulomas with prominent Schaumann bodies, raising suspicion for CBD. Post-transplant testing confirmed beryllium sensitization via lymphocyte proliferation assay. This case highlights the diagnostic challenges of granulomatous ILDs, the importance of comprehensive exposure assessment, and the potential consequences of delayed recognition of CBD.