Among food-related toxic outbreaks that have occurred in the world, the Spanish toxic oil syndrome (TOS) emerges as a significant disaster because of the degree of severity and the huge population involved (1,2). In May 1981 the TOS appeared in Madrid and northwestern areas of Spain as a unique disease caused by the ingestion of adulterated rapeseed oil denatured with aniline (3-7). More than 20,000 people were affected; of these, over 11,000 required hospitalization and over 300 deaths were registered in the first 2 years (1,8). Although the majority of patients recovered after a long period, 30-40% continue to suffer mild symptoms or severe sequelae (9-12). TOS was characterized as a multisystemic disease with three consecutive phases. In the acute phase (1-2 months), patients presented fever, rash, eosinophilia, pulmonary edema, and myalgia. Many patients (59%) progressed to an intermediate phase with pulmonary hypertension, thromboembolism, persistent myalgia and eosinophilia, skin edema, alopecia, and sicca syndrome. The clinical signs of the chronic phase were principally pulmonary hypertension, scleroderma, peripheral neuropathy, and liver disease.
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