Annals of Occupational and Environmental Medicine

Case Report

A case report of toxic hepatitis caused by chloroform in automotive parts manufacturer coating process: Jong Hyun Hwang, Jung Il Kim; Ann Occup Environ Med 2022;34:e22. Published online August 29, 2022; DOI: https://doi.org/10.35371/aoem.2022.34.e22

Abstract Abstract in Korean PDF PubReader ePub

Background

Several cases of chloroform-induced hepatotoxicity have been reported worldwide, but only 2 cases have been reported in Korea. We encountered a case of toxic hepatitis due to chloroform exposure in February 2022 and report the diagnosis process and clinical findings.

Case presentation

A 38-year-old employee in charge of the coating after washing (degreasing) at an automotive parts manufacturer complained of jaundice and was diagnosed with acute toxic hepatitis. After the initial diagnosis, he continued to work, his symptoms worsened, and he was hospitalized for 8 days. Liver ultrasonography (elastography) revealed acute hepatitis. The washing agent contained chloroform, which was not listed on the materials safety data sheet, and the concentrations of chloroform in the workplace were up to 4.7 times the time-weighted average.

Conclusions

This patient showed typical toxic hepatitis with chloroform; further follow-up studies are required. Both employers and workers should be aware of information on toxic substances and take precautions to avoid exposure.

자동차 부품 제조사의 코팅 공정에서 클로로포름에 의해 발생한 독성 간염 1례
배경
클로로포름에 의해 유발된 간 독성은 세계적으로 적은 건수의 보고가 있었으며 국내에서는 단 2건만 보고되었다. 저자는 2022년 2월, 클로로포름으로 인한 독성간염 발생 1예를 경험하였고, 이에 대한 진단과정 및 임상소견을 보고하고자 한다.
사례 보고: 자동차 부품업체에서 세척(탈지) 후 코팅을 담당하는 38세 직원이 황달을 주소로 내원하여 급성독성간염 진단을 받았다. 초기 진단 후에도 계속 업무에 종사하뎠고 증상이 악화되어 8일간 입원 치료하였다. 간 초음파 검사(탄성조영술)에서 급성 간염이 관찰되었다. 세척제에는 MSDS에 등재되지 않은 클로로포름이 포함되어 있으며 작업장 내 클로로포름 농도는 TWA의 4.7배까지 검출되었다.
토의 및 결론: 이 사레는 클로로포름에 의한 전형적인 독성간염을 보여 주었으며 추후 지속적인 추적관찰이 필요하다. 저자는 고용주와 근로자 모두 독성 물질에 대한 정보를 정확히 인식하고 노출을 피하기 위한 예방 조치를 취해야 한다고 강조한다.

Citations

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Case Report

Acute liver injury in two workers exposed to chloroform in cleanrooms: a case report: Young Joong Kang, Jungho Ahn, Yang-In Hwang; Ann Occup Environ Med 2014;26:49. Published online November 4, 2014; DOI: https://doi.org/10.1186/s40557-014-0049-5

Abstract PDF PubReader ePub

We report 2 cases of hepatotoxicity in cleanroom workers due to high retained chloroform air concentrations. The women, aged 34 and 41 years, who had been working in a medical endoscopic device manufacturer as cleanroom workers for approximately 40–45 days suffered severe liver damage. Two measured time-weighted averages of the chloroform concentration in the air in the cleanroom were 82.74 and 64.24 ppm, which are more than 6 times the legal occupational exposure limit in Korea. Only 7% of the cleanroom air was newly introduced from outside. The clinical courses of these cases and workplace inspection, led us to conclude that both cases of hepatotoxicity were caused by chloroform exposure.

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Clinical Journal of Gastroenterology.2023;[Epub] CrossRef
A case report of toxic hepatitis caused by chloroform in automotive parts manufacturer coating process
Jong Hyun Hwang, Jung Il Kim
Annals of Occupational and Environmental Medicine.2022;[Epub] CrossRef
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Clinical Toxicology.2017; 55(2): 147. CrossRef

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Case Report

A Suspicious Case of Chloroform Induced Acute Toxic Hepatitis in Laboratory Worker: Dae Gwang Lee, Chang Hwan Lee, Keun Ho Jang, Hong Jae Chae, Jai Dong Moon; Korean Journal of Occupational and Environmental Medicine 2012;24(3):304-310. Published online September 30, 2012; DOI: https://doi.org/10.35371/kjoem.2012.24.3.304

Abstract PDF

OBJECTIVES
To report upon a case of toxic hepatitis in a worker exposed to chloroform.
METHODS
A 28-year-old female who had worked as chemical analysis engineer in a laboratory using chloroform was hospitalized due to nausea, vomiting and generalized weakness. The authors evaluated her using blood tests, abdominal CT scan and her occupational history.
RESULTS
The blood tests revealed acute toxic hepatitis. Other causes of hepatitis such as viral, drug induced or alcoholic hepatitis could be excluded. But autoimmune hepatitis couldn't be totally ruled out(ANA (++), IgG(serum) 1780 mg/dL). After admission, her symptoms improved and her liver enzyme levels(AST and ALT) were markedly reduced. She returned to her workplace after discharge. Afterwards, however, her liver enzyme levels increased again one week after returning to her workplace. Subsequent to a job change, her liver enzyme levels reduced and normalized after eight weeks. The airbone laboratory chloroform ranged from 3.155 to 9.037 ppm.
CONCLUSIONS
The authors presume that this patient's liver injury was related to an interaction of chloroform toxicity and a predisposition to autoimmune hepatitis. The rapid improvement of the clinical symptoms and the progressive normalization of the liver function tests once the chloroform exposure eliminated supports the diagnosis.

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