There is increasing evidence that sarcoidosis can occur in workplace settings in which there
is exposure to both foreign antigens and inorganic triggers of inflammation that promote an
exuberant granulomatous immune response. It is likely that sarcoidosis has more than one
cause.

Inhalation of metal dust or fume can cause granulomatous lung disease that mimics
sarcoidosis. Particular metals that possess antigenic properties which promote granuloma
formation include aluminum, barium, beryllium, cobalt, copper, gold, rare earths
(lanthanides), titanium, and zirconium. The occupational and environmental exposure
history holds the key to linking such metals with seemingly idiopathic disease. We propose
clinicians use a systematic approach to investigating the occupational and environmental …