Metal fume fever (MFF) has been recognized in the past few centuries as an important occupational disorder in the brass and welding industries (particularly in galvanized steel production), and between 1,500-2,000 workers suffer from this condition in the United States on an annual basis [1] [2] [3] [4]. Inhalation of zinc oxide (ZnO), the principal causative agent of MFF, but also iron and copper oxide in the work setting is considered to be toxic and results in the production of various symptoms [1] [4] [5] [6]. The clinical presentation is distinguished by the onset of a dry cough, dyspnea, fever, chills, headaches, myalgias, fatigue, malaise, and arthralgias within 3-12 hours after exposure to metal-containing fumes [1] [2] [3] [5]. In addition, a metallic taste in the mouth, a dry throat, and excessive salivation have been reported as potential symptoms as well [3] [6]. Complaints usually resolve after 24 hours, but they can persist throughout the initial week and completely disappear by the beginning of the next week [1] [5] [6]. The marked improvement of symptoms over the weekend, when workers are removed from the source of exposure, is often referred to as tachyphylaxis, which is not uncommon for metal fume fever [1] [2] [3] [5]. The condition is self-limiting and rarely poses a significant risk for the patient, but reports have documented the development of pericarditis, pneumonitis and even aseptic meningitis in individuals who were exposed to very high amounts of metal fumes [1] [2] [3]. Furthermore, studies have implicated a potential link between occupational asthma and metal fume fever, with further research needed to confirm these claims [2].

• Fever

  The primary treatment for both metal fume fever and polymer fume fever is supportive and directed at symptom relief. [doi.org]

  Metal fume fever, also known as brass founders' ague, brass shakes, zinc shakes, galvie flu, metal dust fever, Welding Shivers, or Monday morning fever, is an illness primarily caused by exposure to chemicals such as zinc oxide (ZnO), aluminium oxide [en.wikipedia.org]

  Low-grade fever after inhalation exposure is not explicable by hydrogen chloride inhalation and therefore appeared to be caused by titanium dioxide inhalation, manifesting as metal fume fever. [ncbi.nlm.nih.gov]

• Fatigue

  He was referred to the emergency department of our hospital with low-grade fever, dyspnea, headache, fatigue and myalgia. [ncbi.nlm.nih.gov]

  They include fever (rarely exceeding 102 F), chills, nausea, dryness of the throat, couch, fatigue, and general weakness and aching of the head and body. [sentryair.com]

  He described malaise, fatigue, cough, fever, nausea, and dyspnoea at rest. He had no previous medical history of note and was usually fit and well. He was a non-smoker. [doi.org]

• Malaise

  Symptoms include fever, chills, cough, dyspnea, headache, myalgia, and malaise. [ncbi.nlm.nih.gov]

  He complained of malaise, nausea, vomiting, and cough. He had no previous medical history. Examination and investigation were unremarkable. [doi.org]

• Exposure to Metal Fumes

  The diagnosis of metal fume fever is primarily based on the history of exposure to metal fumes and the occurring of symptoms shortly afterwards. [ntvg.nl]

  ", number "6", } TY - JOUR T1 - Copper exposure and metal fume fever T2 - Journal of Occupational and Environmental Hygiene AU - Borak, J. AU - Cohen, H. AU - Hethmon, T. A. [utah.pure.elsevier.com]

  Key points Metal fume fever is generally a benign flu-like illness following exposure to metal fume. Severe symptoms may occur if there is poor exposure control. [doi.org]

  When they return to work, it is important to limit exposure to metal fumes, because they can be more vulnerable to future episodes of illness. [wisegeek.com]

  Key points Metal fume fever is a diagnosed with exposure to metal fumes within the last 48 hours and 'flu-like' symptom development with resolution within 1–2 days. [racgp.org.au]

• Metal Worker

  Metal fume fever is an ancient occupational disease still encountered among metal workers. The delay between exposure and onset of non-specific symptoms makes this an elusive diagnosis. [ncbi.nlm.nih.gov]

  Mortality from infectious pneumonia in metal workers: a comparison with deaths from asthma in occupations exposed to respiratory sensitizers. [hse.gov.uk]

  Metal workers have a high incidence rate of musculoskeletal problems including back injuries, shoulder pain, tendonitis, carpal tunnel, white finger and knee joint issues. Work postures and heavy lifting contribute significant to these problems. [ehs.ua.edu]

• Cough

  The MFF is characterized by fever, cough, sputing, wheezing, chest tightness, fatique, chills, fever, myalgias, cough, dyspnea, leukocytosis with a left shift, thirst, metallic taste, and salivations. [ncbi.nlm.nih.gov]

  He complained of malaise, nausea, vomiting, and cough. He had no previous medical history. Examination and investigation were unremarkable. [doi.org]

• Dyspnea

  He was referred to the emergency department of our hospital with low-grade fever, dyspnea, headache, fatigue and myalgia. [ncbi.nlm.nih.gov]

• Dry Cough

  Possible MFF (at least one of fever, feelings of flu, general malaise, chills, dry cough, metallic taste, or shortness of breath) was reported by 39.2% of apprentices. [ncbi.nlm.nih.gov]

  Patients also frequently complain of a sweet or metallic taste in the mouth, irritated or dry throat, and chest pain. flu-like illness with a metallic taste in the mouth, leucocytosis (high white blood cell count) throat irritation, and dry cough; [online-vitamins-guide.com]

  Abstract A 50-year-old man with a 30-year occupational history of welding presented with low-grade fever, fatigue and persistent dry cough. [doi.org]

  Jeff (email: [email protected]) Don't panic, here's a fact sheet: Symptoms: flu-like illness with a metallic taste in the mouth, throat irritation, and dry cough; Signs: leucocytosis (high white blood cell count) is common; normal chest x-ray [abymc.com]

• Nausea

  Fourteen students and staff complained of nausea, dyspnea, or respiratory irritation immediately after inhaling the gas. On arrival at Saint Luke's International Hospital, more than half of the patients presented with low-grade fever. [ncbi.nlm.nih.gov]

  Clinical findings Several hours after exposure, cough, dry throat, tightness in chest, chills and fever, then sweating, weakness, nausea, myalgia, upper respiratory tract irritation, leukocytosis. [medical-dictionary.thefreedictionary.com]

  He complained of malaise, nausea, vomiting, and cough. He had no previous medical history. Examination and investigation were unremarkable. [doi.org]

  They include fever (rarely exceeding 102 F), chills, nausea, dryness of the throat, couch, fatigue, and general weakness and aching of the head and body. [sentryair.com]

• Metallic Taste

  The MFF is characterized by fever, cough, sputing, wheezing, chest tightness, fatique, chills, fever, myalgias, cough, dyspnea, leukocytosis with a left shift, thirst, metallic taste, and salivations. [ncbi.nlm.nih.gov]

  Patients also frequently complain of a sweet or metallic taste in the mouth, irritated or dry throat, and chest pain. flu-like illness with a metallic taste in the mouth, leucocytosis (high white blood cell count) throat irritation, and dry cough; [online-vitamins-guide.com]

  Individuals affected may have excessive thirst and a metallic taste in their mouth. Symptoms usually subside spontaneously in six to 12 hours. A classic case would occur when galvanized steel is welded in a poorly ventilated area. [imedpub.com]

• Chest Pain

  Forty-five minutes later, he developed flu-like symptoms, shivering, muscle stiffness, dizziness, central chest pain and a metallic taste. [doi.org]

  Patients also frequently complain of a sweet or metallic taste in the mouth, irritated or dry throat, and chest pain. flu-like illness with a metallic taste in the mouth, leucocytosis (high white blood cell count) throat irritation, and dry cough; [online-vitamins-guide.com]

  They include fever, chills, nausea, headache, fatigue, muscle aches, joint pains, lack of appetite, shortness of breath, pneumonia, chest pain, change in blood pressure, and coughing. [en.wikipedia.org]

  Some patients report a metallic taste in their mouths, chest pain, changes in urinary output, and an unusually high white blood cell count. A blood test can reveal abnormally high concentrations of metals in the blood. [wisegeek.com]

  Hot flashes, cold flashes, sweats, chills, terrible chest pains and stomach pains. And for quite a while after, it tasted like I had a mouth full of pennies. -- Chipmaker ICK! [abymc.com]

• Tachycardia

  By 18 h, he was apyrexial with residual mild tachycardia, right basal crepitations, right basal shadowing on chest X-ray and a leucocytosis of 13 000 white blood cells/μl. Electrocardiogram, Doppler and computed tomography brain scan were normal. [doi.org]

  In some cases, affected individuals may exhibit increased salivation; yellowing of the teeth; an unusually rapid heart beat (tachycardia); low levels of iron within the red blood cells (anemia); bluish discoloration (cyanosis) of the skin and mucous membranes [rarediseases.org]

• Pericardial Friction Rub

  Physical examination revealed neck rigidity, maxillary sinus tenderness, coarse breath sounds with crackles bilaterally and a pericardial friction rub. [occmed.oxfordjournals.org]

• Arthralgia

  He also complained of myalgia, arthralgia, feverish sensation, thirst, and general weakness. Symptoms worsened after repeated copper welding on the next day and subsided gradually following two weeks. [jpmph.org]

  Fever Chills Nausea Fatigue Muscle Ache Joint Pain Thirst “The initial symptoms include a sweet metallic taste associated with throat irritation, dyspnea [shortness of breath] and thirst followed by chills, a low-grade fever, myalgia [muscle pain], arthralgias [sentryair.com]

  The clinical presentation is distinguished by the onset of a dry cough, dyspnea, fever, chills, headaches, myalgias, fatigue, malaise, and arthralgias within 3-12 hours after exposure to metal-containing fumes. [symptoma.com]

  VPIC diagnostic criteria for metal fume fever History of exposure to metal fumes within previous 48 hours AND Febrile illness OR respiratory symptoms PLUS at least one symptoms of: malaise myalgias arthralgias headache nausea AND Other illnesses less [racgp.org.au]

• Painful Muscle Cramps

  Other symptoms include joint pain, muscle cramp, fatigue, malaise, headache, vomiting and a metallic taste [ 4 ]. Clinical signs are often minimal but may include pulmonary rhonchi and/or crepitations. [doi.org]

• Headache

  He was referred to the emergency department of our hospital with low-grade fever, dyspnea, headache, fatigue and myalgia. [ncbi.nlm.nih.gov]

  Treatment of mild metal fume fever consists of bedrest, keeping the patient well hydrated, and symptomatic therapy (e.g. aspirin for headaches) as indicated. [en.wikipedia.org]

  Treatment Treatment of metal fume fever consists of bedrest, and symptomatic therapy (e.g. aspirin for headaches) as indicated. [everything2.com]

Recognition of metal fume fever may significantly improve the quality of the patient's life and a comprehensive workup is necessary in order to make the diagnosis. A detailed patient history is perhaps the single most important component of the workup, as identification of the patient's occupancy, exact job description, and confirmation regarding the substances and risks the patient is exposed to is vital in raising clinical suspicion toward MFF [1] [3] [6]. Furthermore, the rapid onset and resolution of symptoms can point to an occupational disease. A complete physical examination that will document all typical signs and symptoms should follow, after which several laboratory studies may be performed. As many patients will have a high leukocyte count and an elevated erythrocyte sedimentation rate (ESR), a complete blood count (CBC) and evaluation of serum inflammatory markers are recommended tests [1] [2] [5]. In addition, serum and urine levels of zinc are often elevated [1]. If an occupational etiology is suspected in patients with constitutional symptoms, plain radiography of the chest is mandatory, and normal findings are observed in most cases, but a diffuse patchy infiltration is seen in severe cases [5]. Because direct tests to confirm MFF do not exist, the physician must gather all the necessary information through history taking, physical examination and laboratory studies and make the diagnosis based on his/her clinical judgment [1] [6].

• Pulmonary Infiltrate

  Pulmonary infiltrates and hypoxemia are not consistent with pure metal fume fever. [accessmedicine.mhmedical.com]

• X-Ray Abnormal

  Chest X-ray abnormalities may also be present.An interesting feature of metal fume fever involves rapid adaptation to the development of the syndrome following repeated metal oxide exposure. [en.wikipedia.org]

  Chest X-ray abnormalities may also be present. [10] An interesting feature of metal fume fever involves rapid adaptation to the development of the syndrome following repeated metal oxide exposure. [everything.explained.today]

• Chest X-Ray Abnormal

  Chest X-ray abnormalities may also be present.An interesting feature of metal fume fever involves rapid adaptation to the development of the syndrome following repeated metal oxide exposure. [en.wikipedia.org]

  Chest X-ray abnormalities may also be present. [10] An interesting feature of metal fume fever involves rapid adaptation to the development of the syndrome following repeated metal oxide exposure. [everything.explained.today]

• Pericardial Effusion

  He was discharged in good condition, and his pericardial effusion completely resolved 1 week later. [occmed.oxfordjournals.org]

1. Wardhana, Datau EA. Metal fume fever among galvanized welders. Acta Med Indones. 2014;46(3):256-262.
2. El-Zein M, Infante-Rivard C, Malo J, Gautrin D. Is metal fume fever a determinant of welding related respiratory symptoms and/or increased bronchial responsiveness? A longitudinal study. Occup Environ Med. 2005;62(10):688-694.
3. Hassaballa HA, Lateef OB, Bell J, Kim E, Casey L. Metal fume fever presenting as aseptic meningitis with pericarditis, pleuritis and pneumonitis. Occup Med (Lond). 2005;55(8):638-641.
4. Kasper DL, Fauci AS, Hauser SL, Longo DL, Jameson J, Loscalzo J. eds. Harrison's Principles of Internal Medicine, 19e. New York, NY: McGraw-Hill; 2016.
5. Greenberg MI, Vearrier D. Metal fume fever and polymer fume fever. Clin Toxicol (Phila). 2015;53(4):195-203.
6. Kaye P, Young H, O’Sullivan I. Metal fume fever: a case report and review of the literature. Emerg Med J. 2002;19(3):268-269.