Tuberc Respir Dis.  2014 Feb;76(2):75-79. 10.4046/trd.2014.76.2.75.

A Case of Occupational Hypersensitivity Pneumonitis Associated with Trichloroethylene

• Kim YJ
• Hwang ED
• Leem AY
• Kang BD
• Chang SY
• Kim HK
• Park IK
• Kim SY
• Kim EY
• Jung JY
• Kang YA
• Park MS
• Kim YS
• Kim SK
• Chang J
• Chung KS

• KMID: 1877344
• DOI: http://doi.org/10.4046/trd.2014.76.2.75

Abstract

Trichloroethylene (TCE) is a toxic chemical commonly used as a degreasing agent, and it is usually found in a colorless or blue liquid form. TCE has a sweet, chloroform-like odor, and this volatile chlorinated organic chemical can cause toxic hepatitis, neurophysiological disorders, skin disorders, and hypersensitivity syndromes. However, the hypersensitivity pneumonitis (HP) attributed to TCE has rarely been reported. We hereby describe a case of HP associated with TCE in a 29-year-old man who was employed as a lead welder at a computer repair center. He was installing the capacitors on computer chip boards and had been wiped down with TCE. He was admitted to our hospital with complaints of dry coughs, night sweats, and weight losses for the past two months. HP due to TCE exposure was being suspected due to his occupational history, and the results of a video-associated thoracoscopic biopsy confirmed the suspicions. Symptoms have resolved after the steroid pulse therapy and his occupational change. TCE should be taken into consideration as a potential trigger of HP. Early recognition and avoidance of the TCE exposure in the future is important for the treatment of TCE induced HP.

Keyword

Alveolitis, Extrinsic Allergic; Trichloroethylene; Occupational Exposure; Lung Diseases

MeSH Terms

Adult
Alveolitis, Extrinsic Allergic*
Biopsy
Cough
Drug-Induced Liver Injury
Humans
Hypersensitivity*
Lung Diseases
Occupational Exposure
Odors
Skin
Sweat
Trichloroethylene*
Weight Loss
Trichloroethylene

Figure

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  Figure 1 (A) Chest X-ray: some reticulonodular densities on both upper lobes. (B) Pulmonary function test: forced vital capacity (FVC) 4.58 L (90% ref), forced expiratory volume in 1 second (FEV1) 3.87 L (91% ref), FEV1/FVC 84%, FEF25-65% 3.61 L/sec (82% ref), DLCO 23.1 mL/mm Hg/min (83% ref). TLC: total lung capacity; ERV: expiratory reserve volume; RV: residual volume.

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  Figure 2 Tiny ill-defined nodules, predominant on both upper lobes, suggestive of hypersensitivity pneumonitis.

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  Figure 3 Multifocal patchy young fibroblastic proliferation, chronic inflammatory cell infiltration around respiratory bronchiole associated with foamy histiocytic aggregations (H&E stain, ×100).

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  Figure 4 Near complete resolution.

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  Figure 5 Outline of the clinical course and treatment. TBLB: transbronchial lung biopsy; VATS: video-associated thoracoscopy; CT: computed tomography.

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