Trichloroethylene Hypersensitivity Syndrome: A Disease of Fatal Outcome

Abstract

Trichloroethylene is commonly used as an industrial solvent and degreasing agent. The clinical features of acute and chronic intoxication with trichloroethylene are well-known and have been described in many reports, but hypersensitivity syndrome caused by trichloroethylene is rarely encountered. For managing patients with trichloroethylene hypersensitivity syndrome, avoiding trichloroethylene and initiating glucocorticoid have been generally accepted. Generally, glucocorticoid had been tapered as trichloroethylene hypersensitivity syndrome had ameliorated. However, we encountered a typical case of trichloroethylene hypersensitivity syndrome refractory to high dose glucocorticoid treatment. A 54-year-old Korean man developed jaundice, fever, red sore eyes, and generalized erythematous maculopapular rashes. A detailed history revealed occupational exposure to trichloroethylene. After starting intravenous methylprednisolone, his clinical condition improved remarkably, but we could not reduce prednisolone because his liver enzyme and total bilirubin began to rise within 2 days after reducing prednisolone under 60 mg/day. We recommended an extended admission for complete recovery, but the patient decided to leave the hospital against medical advice. The patient visited the emergency department due to pneumonia and developed asystole, which did not respond to resuscitation.

Trichloroethylene Hypersensitivity Syndrome: Should Be Considered When Diagnosing DRESS Syndrome

“…There are 6 reported Korean cases of TCE HS, and the most recent case was reported in 2016. 2 3 4 5 In our case, the patient's clinical pattern and laboratory data were similar to those of DRESS syndrome, although the interval between drug contact and skin disease development was short. Therefore, this is a case of TCE HS in which the diagnosis was confirmed after examining the patient's work history.…”

Exposure Cessation During Adulthood Did Not Prevent Immunotoxicity Caused by Developmental Exposure to Low-Level Trichloroethylene in Drinking Water

“…This reversal encompasses both the dermatitis and the hepatitis associated with the disorder. However, the immune pathology initiated by occupational TCE exposure is sometimes irrevocable, resulting in the death of approximately 20% of patients with TCE-induced hypersensitivity, even after they have been removed from the workplace (Jung et al, 2012;Tan et al, 1997;Xu et al, 2009). Little is known about the reversibility of immune dysregulation caused by developmental TCE exposure.…”

Exposure reconstruction of trichloroethylene among patients with occupational trichloroethylene hypersensitivity syndrome

“…These manifestations occur after occupational TCE exposure for an average duration of 1 month and correspond to those observed in drug-induced HS or drug reaction with eosinophilia and systemic symptoms, a disease entity involving severe adverse cutaneous reactions to drugs 1 , 3 ) . Importantly, two particular cases have been reported who refused to receive necessary medication, and died after returning to their workplaces 4 , 5 ) . Given that eight TCE HS cases have so far been reported in Japan 2 , 6 , 7 , 8 ) , the disease prevention should be taken into account not only in developing but developed countries.…”