Yonsei Med J.  2012 Jan;53(1):231-235. 10.3349/ymj.2012.53.1.231.

Trichloroethylene Hypersensitivity Syndrome: A Disease of Fatal Outcome

• Jung HG
• Kim HH
• Song BG
• Kim EJ

• KMID: 1779713
• DOI: http://doi.org/10.3349/ymj.2012.53.1.231

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.

Keyword

Trichloroethylene; hypersensitivity; hepatitis; occupational exposure; sepsis

MeSH Terms

Dermatitis, Occupational/*etiology
Fatal Outcome
Humans
Hypersensitivity/*etiology
Male
Middle Aged
Occupational Exposure/*adverse effects
Solvents/*toxicity
Trichloroethylene/*toxicity

Figure

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  Fig. 1 Generalized maculopapular skin eruption with exfoliation is observed.

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  Fig. 2 Histologic examination of the patient's skin showed subepidermal clefting and bulla formation, with necrotic keratinocytes in the middle and lower epidermis. Vacuolar degeneration was evident in the basal layer, and there was an infiltrate of lymphocytes in the upper dermis and perivascular area (hematoxylin and eosin staining, ×100).

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