Marked elevation of urinary zinc levels and pleural-friction rub in metal fume fever

Zinc fume is a well-recognized cause of metal fume fever, characterized by acute or subacute symptoms of respiratory tract inflammation, myalgias and fever (similar to influenza) associated with a variety of metal oxide fumes. A welder of galvanized steel developed metal fume fever, a pleural friction rub and markedly elevated urinary zinc excretion despite work-site surveillance data indicating exposures close to the Occupational Safety and Health Administration, Permissible Exposure Limit. This patient suggests that exposure data may be misleading. This case had the highest urine zinc levels reported in the literature and a previously unreported coexistent pleural friction rub. The symptoms resolved with administrative and engineering controls to decrease exposure.