Grand Rounds: An Outbreak of Toxic Hepatitis among Industrial Waste Disposal Workers

Abstract

ContextIndustrial waste (which is composed of various toxic chemicals), changes to the disposal process, and addition of chemicals should all be monitored and controlled carefully in the industrial waste industry to reduce the health hazard to workers.Case presentationFive workers in an industrial waste plant developed acute toxic hepatitis, one of whom died after 3 months due to fulminant hepatitis. In the plant, we detected several chemicals with hepatotoxic potential, including pyridine, dimethylformamide, dimethylacetamide, and methylenedianiline. The workers had been working in the high-vapor-generating area of the plant, and the findings of pathologic examination showed typical features of acute toxic hepatitis.DiscussionInfectious hepatitis and drug-induced hepatitis were excluded by laboratory findings, as well as the clinical course of hepatitis. All cases of toxic hepatitis in this plant developed after the change of the disposal process to thermochemical reaction–type treatment using unslaked lime reacted with industrial wastes. During this chemical reaction, vapor containing several toxic materials was generated. Although we could not confirm the definitive causative chemical, we suspect that these cases of hepatitis were caused by one of the hepatotoxic agents or by a synergistic interaction among several of them.Relevance to clinical or professional practiceIn the industrial waste treatment process, the danger of developing toxic hepatitis should be kept in mind, because any subtle change of the treatment process can generate various toxic materials and threaten the workers’ health. A mixture of hepatotoxic chemicals can induce clinical manifestations that are quite different from those predicted by the toxic property of a single agent.

Trichloroethylene Hypersensitivity Syndrome: A Disease of Fatal Outcome

“… 15 This kind of idiosyncratic hepatitis can be caused by other organic solvents, N, N-dimethylformamide and dimethylacetamide. 16 The mechanism of hepatitis associated with TCE hypersensitivity syndrome may be similar to halothane hepatitis. 17 Like halothane, TCE is a two carbon poly-halogenated hydrocarbon.…”

4,4′-Methylenedianiline-induced hepatitis in an industrial worker: Case report and review of the literature

“…23 Several additional cases of accidental exposure to MDA have been described, mostly via inhalation, in workers in the manufacturing process of insulating materials and in blending of epoxy resins. [24][25][26] In almost every case, there was also direct skin contact with MDA. Clinical findings included abdominal pain and discomfort, jaundice, nausea and malaise.…”

“…An outbreak of toxic hepatitis in industrial waste disposal workers has been described by Cheong et al, 25 which included a fatal case. However, 2 out of 5 workers had preexisting liver disease and 2 others mentioned concurrent intake of herbal medicines and non-steroid anti-inflammatory agents, which may have contributed to the liver injury.…”

“…Moreover, besides MDA, several other potential hepatotoxins were detected in the working environment of these patients, including several solvents; therefore, the causative agent was not clearly defined. 25 Acute toxicity of MDA involves hepatitis with cholestasis. The liver biopsy that was performed in our patient on the 7th day after admission revealed diffuse cellular infiltration, marked cholestasis and moderate fibrosis.…”

Clinical manifestation score and characterization of cytokines and lymphocytes of dimethylacetamide-induced toxic hepatitis in spandex workers

“…DMAc-induced liver injuries, such as fat infiltration, biliary hyperplasia, hepatocyte degeneration, and necrosis, have been reported in animal models (Wang and Chen, 2020). Frequent occurrence of toxic hepatitis due to occupational overexposure has been reported with increasing worldwide use of DMAc (Antoniou et al, 2021; Cheong et al, 2007; Juma et al, 2021; Kennedy, 2012). Glutathione (GSH) has been shown to inhibit DMAc-induced hepatocyte apoptosis, thus playing an effective preventive role (Liu et al, 2016; Song et al, 2018).…”