Annals of Occupational and Environmental Medicine

Case Report

Recognized cases of amyotrophic lateral sclerosis in automobile workers by the Korean Epidemiologic Investigation Evaluation Committee: Yongjin Kim, Jong-Hyeop O, Hyungyoel Cho, Shinhee Ye; Ann Occup Environ Med 2024;36:e28. Published online October 17, 2024; DOI: https://doi.org/10.35371/aoem.2024.36.e28

Abstract Abstract in Korean PDF PubReader ePub: Background
Three automobile company workers (one from Factory D and two from Factory E) were diagnosed with amyotrophic lateral sclerosis. The Korean Epidemiologic Investigation and Evaluation Committee determined that there is considerable scientific evidence supporting the association between amyotrophic lateral sclerosis and combined exposure to heavy metals, organic solvents, and diesel exhaust at the manufacturing plant. Case presentation: Patient A, who primarily engaged in engine processing and completed vehicle inspection at Factory D, was exposed to considerable amounts of heavy metals and organic solvents during medium- and large-engine processing, welding, and painting for over 23 years. Additionally, the patient was likely exposed to diesel exhaust for 33 years from forklifts delivering engines in the workshop. Patients B and C, who were responsible for engine assembly, ignition testing, and engine shipment at Factory E since around 1990, were exposed to lead and benzene from gasoline during engine ignition tests in the engine department for 15 and 16 years, respectively. They also encountered welding fumes, heavy metals, and organic solvents during welding and painting tasks. In addition, Patients B and C were continuously exposed to diesel exhaust from logistics vehicles on standby during work hours for 25 and 30 years, respectively. Conclusions: Although the specific level of lead exposure causing amyotrophic lateral sclerosis remains undetermined, numerous studies have consistently reported a relationship between lead exposure and disease development. Limited evidence suggests that exposure to organic solvents and diesel exhaust may increase the risk of amyotrophic lateral sclerosis. Therefore, the Epidemiological Investigation and Evaluation Committee concluded that the three patients’ work-related exposure to heavy metals, organic solvents, and diesel exhaust is significantly supported by scientific evidence as a cause of their amyotrophic lateral sclerosis.; 일개 자동차 회사 근로자에서 발생한 근위축성 측삭경화증: 3개 사례보고
배경
일개 자동차 회사의 3명의 근로자(공장 D에서 1명, 공장 E에서 2명)가 근위축성 측삭경화증(Amyotrophic lateral sclerosis) 진단을 받았다. 역학조사평가위원회는 근로자에서 중금속, 유기용제, 디젤 배기가스에 대한 복합 노출과 근위축성 측삭경화증 발병 사이에 상당한 과학적 증거가 있다고 판단하였다.
증례
근로자 A는 공장 D에서 주로 엔진 가공 및 완성 차량 검사 업무를 담당하며, 약 23년 동안 중대형 엔진 가공, 용접 및 도장 작업 중 상당한 양의 중금속 및 유기용제에 노출되었다. 또한, 약 33년동안 지게차로 엔진을 운반하는 업무를 하며 발생하는 디젤 배기가스에 노출되었다. 근로자 B와 C는 1990년대 초부터 공장 E에서 엔진 조립, 엔진 착화테스트 및 엔진 출하 업무를 담당했으며, 각각 약 15년, 약 16년 동안 엔진 착화테스트 업무를 하며 휘발유에 포함된 납 및 벤젠 등에 노출되었다. 그리고 용접 및 도장 작업을 하며 용접 흄, 중금속 및 유기용제 등에 노출되었다. 또한 근로자 B와 C는 각각 약 25년, 약 30년 동안 작업 중 인근에 대기 중인 물류 차량으로부터 지속적으로 디젤 배기가스에 노출되었다.
결론
근위축성 측삭경화증을 발생시킬 수 있는 납 노출 수준은 명확하게 밝혀지지 않았지만, 비교적 많은 연구에서 납 노출과 질병의 발병 사이 관계를 일관되게 보고하고 있었다. 유기용제 및 디젤 배기가스에 대한 노출이 근위축성 측삭경화증의 발생 위험을 증가시킬 수 있다는 제한적인 증거도 있었다. 따라서, 역학조사평가위원회는 3명의 근로자가 근무 중 노출된 중금속, 유기용제 및 디젤 배기가스가 근위축성 측삭경화증의 원인이라는 과학적 근거가 상당하다고 판단하였다.

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Case Report

A Case of Amyotrophic Lateral Sclerosis in an Equipment Maintenance Worker Exposed to Lead: In Ki Yoon, Hyoung Jun Lim, Young Su Ju, Se Jin An, Young Jun Kwon; Korean Journal of Occupational and Environmental Medicine 2012;24(2):195-205. Published online June 30, 2012; DOI: https://doi.org/10.35371/kjoem.2012.24.2.195

Abstract PDF: OBJECTIVES
Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease involving the upper and lower motor neuron of the brain and spinal cord, leading ultimately to death due to respiratory failure in most cases. The etiology of ALS is currently unknown, but several studies show that lead exposure might be one of the potential environmental causes of ALS. In this perspective, we introduce a case involving an ALS patient exposed to lead while maintaining mechanical equipment in a waste treatment plant.
METHODS
The patient was interviewed and his medical records were investigated to confirm the final diagnosis of ALS. The results of his health examination and working environment measurement were reviewed in order to evaluate the relation of his work with ALS. We also performed an analysis of lead concentration from samples taken from his workplace when we visited the plant to survey the work environment.
RESULTS
Based on the patient's clinical information, work environment, relatively high level of blood lead concentration, and several studies proposing the occupational relationship between lead and ALS, his ALS may possibly have been caused by lead exposure at his workplace.
CONCLUSIONS
Given the recent situation where the causal association between lead exposure and ALS is still unclear, this case report could be used as a basis to support the relevance of lead exposure with ALS, and to help improve the health and work environment of other workers who are likely to be exposed to lead.

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Case Report

A Case of Amyotrophic Lateral Sclerosis in a Worker Treating Pesticide Wastes: Soon Choy, Jung Won Kim; Korean Journal of Occupational and Environmental Medicine 2011;23(4):480-487. Published online December 31, 2011; DOI: https://doi.org/10.35371/kjoem.2011.23.4.480

Abstract PDF

BACKGROUND
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease involving the motor neuron of the cerebrum, brain stem, and spinal cord. It has been suggested that various occupational or environmental agents could be a cause of ALS. We report upon a case of a person contracting ALS who experienced a long-time exposure to pesticides, implying that pesticides are probable causal agents of ALS.
CASE REPORTS
The patient has been experiencing shoulder pain and limitation of movement that started abruptly about three years ago. Over time, these symptoms have become aggravated despite ongoing therapies including medication. After two years, he was diagnosed with ALS through electromyography, nerve conduction velocity and many laboratory tests at a university hospital in Seoul. His social and medical history was non-specific. The patient had worked for about 15 years at a waste disposal site and mainly destroyed glass bottles containing pesticides. During this period, his respiratory tract and skin were exposed to various raw pesticides without appropriate personal protective equipment. He did this job one or two times a week and worked for two or more hours without a break. Through an investigation into the patient's working environment, significant levels of dichlorvos, one of the organophosphates, were detected.
CONCLUSIONS
The study results revealed that the patient was exposed to considerable doses of pesticides as opposed to men spraying pesticides. Although controversial, pesticide exposures have been associated with ALS. However, we suggest that in this case the possibility that these pesticide exposures acted as a causal agent for the diagnosed ALS based on plausible biological mechanisms and epidemiologic data.

Citations

Citations to this article as recorded by

Amyotrophic Lateral Sclerosis and Agricultural Environments: A Systematic Review
Hyun Kang, Eun Shil Cha, Geun Joo Choi, Won Jin Lee
Journal of Korean Medical Science.2014; 29(12): 1610. CrossRef
Pesticides and human chronic diseases: Evidences, mechanisms, and perspectives
Sara Mostafalou, Mohammad Abdollahi
Toxicology and Applied Pharmacology.2013; 268(2): 157. CrossRef

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