Extrapulmonary Manifestations of Chronic Beryllium Disease

Background While sarcoidosis can present with extrapulmonary manifestations, systemic involvement in chronic beryllium disease (CBD) has been reported only anecdotally. We describe 6 cases of CBD with multiorgan involvement. Methods Retrospective case series of patients with confirmed CBD and extrapulmonary manifestations. Results All six patients were males, ages 42-61, with occupational beryllium exposure (metalworking, mining, nuclear industry, energy sector). CBD was confirmed in all cases by positive lymphocyte proliferation test (LPT) and granulomas on histology. Besides pulmonary disease, all patients displayed features of systemic involvement: Case 1 presented with jaundice, later linked to histologically proven hepatic and gastric granulomatous involvement. Case 2 had severe neurologic symptoms (ataxia, dysarthria, spasticity) and myalgias. MRI revealed intracerebral lesions typical of neurosarcoidosis, while PET showed intramuscular hypermetabolic lesions. Case 3 developed steroid-responsive hypercalciuria and chronic kidney disease. Furthermore, PET showed spleen involvement and MRI possible cardiac involvement. Case 4 had histologically proven kidney and skin involvement. Case 5 developed bilateral posterior uveitis and hypercalcemia. Case 6 presented with visual field loss, caused by intracerebral and optic nerve sheath masses revealed by MRI, with confirmed meningeal granulomas on biopsy. Discussion This series demonstrates that CBD can present with diverse systemic manifestations mimicking sarcoidosis. Extrapulmonary CBD, although recently reported in European cohorts, is almost never encountered in the USA. This geographic disparity may reflect different screening practices leading to later detection in Europe or different exposure patterns. In conclusion, thorough assessment of occupational exposures and LPT testing should be considered in all patients with sarcoidosis-like granulomatous disease, regardless of the extent of systemic involvement. Clinicians managing CBD patients should maintain vigilance for extrapulmonary manifestations similar the approach in sarcoidosis care. Publication History Article published online: 04 March 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany