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Exposure Level of Trichloroethylene in Stevens-Johnson Syndrome Due to Occupational Exposure: 3 Case Reports and a Review of Other Cases
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Sun Wung Lee, Eun A Kim, Dae Sung Kim, Dong hee Koh, Seong Kyu Kang, Byung Kyu Kim, Min Ki Kim
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Korean Journal of Occupational and Environmental Medicine 2008;20(2):132-146. Published online June 30, 2008
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DOI: https://doi.org/10.35371/kjoem.2008.20.2.132
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 Abstract
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- BACKGROUND
Trichloroethylene (TCE) has been reported to be related to severe generalized exfoliative dermatitis frequently accompanied by toxic hepatitis. The measurements of environmental exposure were limited in the previous case reports and the reported exposure values were also diverse. We reviewed three cases of Stevens-Johnson syndrome associated with TCE. The work environment was measured by the Korea Occupational Safety and Health Agency (KOSHA) after the cases occurred. From the study results, we intended to clarify the relationship between TCE exposure level and Stevens- Johnson syndrome.
CASE
REPORT: Case 1. A 24-year-old Filipino female worker developed a skin rash 35 days after starting to use TCE for degreasing. The skin rash developed into a bullous eruption and the liver function findings were abnormal. She was diagnosed with Stevens-Johnson syndrome and toxic hepatitis. She died of hepatic failure 39 days after the onset of the first symptom. She had no previous history of taking medicine or viral infection. The work environment measured 22.0 to 32.3 ppm (personal exposure level) with TWA. Case 2. A 47-year-old Korean male worker developed a skin rash, 20 days after starting to use TCE for degreasing. The skin rash developed into a bullous eruption and the liver function findings were abnormal. He was diagnosed with Stevens-Johnson syndrome, toxic hepatitis and sepsis. He died of hepatic failure and sepsis 42 days after the onset of the first symptom. He had no previous history of taking medicine or viral infection. The work environment measured 30.1 ppm (personal exposure level) and 116.5~229.7 ppm (area exposure level close to the degreasing machine) with TWA. Case 3. A 22-yearold Vietnamese female worker developed a skin rash 30 days after starting to use TCE for degreasing. The skin rash developed into a bullous eruption and the liver function findings were abnormal. She was diagnosed with Stevens-Johnson syndrome and toxic hepatitis. Her symptoms improved and she was discharged 37 days after the onset of the first symptom. She had no previous history of taking medicine or viral infection. The work environment measured 107.2 ppm (personal exposure level) with TWA.
DISCUSSION
These three case reports and the previously reported cases indicated that the majority of people susceptible to TCE develops Stevens-Johnson syndrome after high-level TCE exposure (above the TWA occupational exposure limit of 50 ppm). Therefore, work environmental survey and improvements to the TCE degreasing process are essential to prevent high exposure. Furthermore, considering the consistency of the latency period in symptoms and the possibility of sensitization in low-level exposure, we recommend that the first specific health examination also should be conducted 1 month after workers have commenced working.
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Citations
Citations to this article as recorded by  - Occupational Inhalation Health Risk Assessment of TCE Exposure in the Korean Manufacturing Industry
Sueji Seo, Saemi Shin, Sanghoon Byeon
Applied Sciences.2024; 14(13): 5510. CrossRef - A case report of toxic hepatitis caused by chloroform in automotive parts manufacturer coating process
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Annals of Occupational and Environmental Medicine.2022;[Epub] CrossRef - Trichloroethylene Hypersensitivity Syndrome: Should Be Considered When Diagnosing DRESS Syndrome
Young Joong Kang, Jihye Lee, Jungho Ahn, Soonwoo Park, Mu Young Shin, Hye Won Lee
Journal of Korean Medical Science.2018;[Epub] CrossRef - Acute Occupational Poisoning in Korea
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The Ewha Medical Journal.2016; 39(4): 99. CrossRef - Late-onset trichloroethylene-induced hypersensitivity syndrome after intermittent exposure to low-dose trichloroethylene
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Allergy, Asthma & Respiratory Disease.2016; 4(2): 145. CrossRef - Compensation for Work-Related Hematologic, Liver, and Infectious Diseases
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Journal of Korean Medical Science.2014; 29(Suppl): S66. CrossRef - Occupational Hepatic Disorders in Korea
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Journal of Korean Medical Science.2010; 25(Suppl): S36. CrossRef - Extensive changes to occupational exposure limits in Korea
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Regulatory Toxicology and Pharmacology.2010; 58(2): 345. CrossRef - Occupational Diseases in Korea
Seong-Kyu Kang, Eun A Kim
Journal of Korean Medical Science.2010; 25(Suppl): S4. CrossRef - Current status of liver diseases in Korea: Toxic and alcoholic liver diseases
Kyung-Ah Kim
The Korean Journal of Hepatology.2009; 15(Suppl 6): S29. CrossRef
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