Annals of Occupational and Environmental Medicine

Case Report

Exposure Level of Trichloroethylene in Stevens-Johnson Syndrome Due to Occupational Exposure: 3 Case Reports and a Review of Other Cases: Sun Wung Lee, Eun A Kim, Dae Sung Kim, Dong hee Koh, Seong Kyu Kang, Byung Kyu Kim, Min Ki Kim; Korean Journal of Occupational and Environmental Medicine 2008;20(2):132-146. Published online June 30, 2008; DOI: https://doi.org/10.35371/kjoem.2008.20.2.132

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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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
Jong Hyun Hwang, Jung Il Kim
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
Hyunjoo Kim, Jia Ryu
The Ewha Medical Journal.2016; 39(4): 99. CrossRef
Late-onset trichloroethylene-induced hypersensitivity syndrome after intermittent exposure to low-dose trichloroethylene
Seung Yun Lee, Se Hwan Oh, Hyuck Jae Choi, Woo Young Choi, Jee Young Han, Hong-Lyeol Lee, Cheol-Woo Kim
Allergy, Asthma & Respiratory Disease.2016; 4(2): 145. CrossRef
Compensation for Work-Related Hematologic, Liver, and Infectious Diseases
Jung-Won Kim, Dong-Mug Kang
Journal of Korean Medical Science.2014; 29(Suppl): S66. CrossRef
Occupational Hepatic Disorders in Korea
Hyoung Ryoul Kim, Tae Woo Kim
Journal of Korean Medical Science.2010; 25(Suppl): S36. CrossRef
Extensive changes to occupational exposure limits in Korea
Jee Yeon Jeong, Sangjun Choi, Young Lim Kho, Pan Gyi Kim
Regulatory Toxicology and Pharmacology.2010; 58(2): 345. CrossRef
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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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Original Article

Prevalence of Occupational Asthma and Exposure Level of Pharmaceutical Dust of Workers in a Pharmaceutical Company: Sung Soo Oh, Yong Hyu Choi, Eun A Kim, Young Mok Lee, Jae Kil Jang, Jang Jin Yoo, Seung Hyun Park, Soo Young Jung, Tae Kyun Kim, Kyoo Sang Kim, Seong Kyu Kang; Korean Journal of Occupational and Environmental Medicine 2006;18(2):94-102. Published online June 30, 2006; DOI: https://doi.org/10.35371/kjoem.2006.18.2.94

Abstract PDF

OBJECTIVES
After the investigation of one worker with occupational asthma, we surveyed the prevalence of occupational asthma and the exposure level of pharmaceutical dust of 32 workers in a pharmaceutical company.
METHODS
Thirty-two of the 90 employees participated in the survey which consisted of questionnaire, blood sampling, spirometry and skin prick tests with 8 common allergens as well as 9 antibiotics and 2 enzymes. Various indices of the working environment were also measured. Subjects who had a symptom suggestive of work-related asthma or positive skin prick test were further investigated by PC20 methacholine. Nine subjects who had a PC20 result of 16 mg/ml or less (n=7) or had work-related symptoms and positive skin prick test (n=2) were referred to undergo a specific bronchial provocation test to pharmaceutical dust in an academic allergic disease center.
RESULTS
Eleven of 32 workers (34.4%) had a work-related symptom suggestive of occupational asthma. Ten (31.2%) showed positive skin prick test. 8 (25.0%) had a PC20 result of 16 mg/ml or less (indicative of significant bronchial hyperresponsiveness), and 5 (15.6%) had a positive result on the specific bronchial provocation test. Exposure levels of stuffing, input of raw materials and screening process were relatively high.
CONCLUSIONS
This survey showed that pharmaceutical workers have an increased risk of occupational asthma. Although pharmaceutical factories maintain a relatively good working environment, careful control of respiratory tract exposures, especially during stuffing, input of raw materials and screening process, is important to prevent occupational asthma. Pharmaceutical workers need to undergo regular skin prick and methacholine bronchial provocation tests, as well as asthmatic symptom survey, to ensure the early detection and prevention of occupational asthma.

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Occupational Diseases in Korea
Seong-Kyu Kang, Eun A Kim
Journal of Korean Medical Science.2010; 25(Suppl): S4. CrossRef

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Original Article

Acquried Dyschromatopsia in Women Workers in Shoe Manufacturing Who were Exposed to Organic Solvents: Joo Hyun Byun, Kwang Young Lee, Young Kee Kim, Kwang Wook Ko, Yong Hwan Lee; Korean Journal of Occupational and Environmental Medicine 2001;13(3):232-241. Published online September 30, 2001; DOI: https://doi.org/10.35371/kjoem.2001.13.3.232

Abstract PDF

OBJECTIVES
This study was undertaken to investigate the relationship between color vision defects and occupational exposure to mixed organic solvents in women workers who were engaged in the shoe manufacturing industry.
METHODS
A total of 173 women workers were involved in this study, 85 of whom were exposed to mixed organic solvents and were defined as the exposed group, and 88 workers comprised the non-exposed control group. The patients were questioned as to their drinking history, the year in which they were exposed and whether they had eye symptoms of blurred vision, eye fatigue, and eye irritation. The exposed workers in the shoe manufacturing factory were engaged in 3 work areas which were pasting, trimming, and cleaning. Their Color vision was assessed using the Hahn's double 15 hue test under standard illumination and their current and cumulative exposure levels were measured.
RESULTS
The prevalence of color vision defect was 21.2% in the exposed group and 8.0% in the control group, and the blue-yellow defect was found to be 5.9 % in the exposed group. The logistic regression for the acquired dyschromatopsia and color confusion index showed that there were no variables that had significant relationships. Eye symptoms were more frequently developed in the exposed group.
CONCLUSIONS
There is a possibility of developing color vision defects when workers are exposed to mixed organic solvents. However, the results of the color confusion index showed that there was no significant relationship to the cumulative exposure level, because of the low exposure level and high occupational turn over rate of the workers. Because the workers in the present study were exposed to low level solvents it will be necessary to study workers exposed to higher levels of organic solvents.

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Hyun-Sun Jeong, Kyoung-Mu Lee
Journal of Environmental Health Sciences.2023; 49(6): 372. CrossRef
Impaired colour vision in workers exposed to organic solvents: A systematic review
A.M. Betancur-Sánchez, E.M. Vásquez-Trespalacios, C. Sardi-Correa
Archivos de la Sociedad Española de Oftalmología (English Edition).2017; 92(1): 12. CrossRef
Discromatopsias y exposición a solventes orgánicos: una revisión sistemática
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Archivos de la Sociedad Española de Oftalmología.2017; 92(1): 12. CrossRef
Color vision impairments among shipyard workers exposed to mixed organic solvents, especially xylene
Eun-Hee Lee, Domyung Paek, Young Lim Kho, Kyungho Choi, Hong Jae Chae
Neurotoxicology and Teratology.2013; 37: 39. CrossRef
Usefulness of Color Vision Test for Early Detection of Neurological Damages by Neurotoxic Substances
Eun-Hee Lee, Kyungho Choi, Hong Jae Chae, Domyung Paek
Journal of Preventive Medicine and Public Health.2008; 41(6): 397. CrossRef

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Original Article

Effect of Aldehyde dehydrogenase2 (ALDH2) Genotypes in Urinary Hippuric Acid Excretion as a Biological Exposure Index of Toluene: Seong Sil Chang, Chung Yill Park, Kang Sook Lee, Young Man Roh; Korean Journal of Occupational and Environmental Medicine 1996;8(3):454-465. Published online December 31, 1996; DOI: https://doi.org/10.35371/kjoem.1996.8.3.454

Abstract PDF

We investigated toluene exposure level, urinary hippuric acid concentrations, subjective symptoms and genotype of ALDH2 DNA in 134 exposed workers and 53 nonexposed workers for evaluating the effect of ALDH2 polymorphism on toluene metabolism and urinary hippuric acid concentration as biological exposure indices (BEI) of toluene. The results were as follows; 1. The percentage of inactive genotype of ALDH2 in exposed workers was lower than that of exposed (P=0.081). 2. The percentages of exposed workers with inactive genotype did not have any significant difference by the increase of toluene exposure level or work duration. 3. The frequency of drinking, monthly and maximum amount of alcohol intake in workers with normal genotype were significantly higher than those with inactive genotype. 4. The urinary hippuric acid concentration of nonexposed workers ,with inactive genotype was significantly lower than that with normal genotype. Under 100 ppm of toluene, similar but statistically insignificant trends were found, while above that concentration of toluene, reverse but statistically insignificant trends were found. 5. The number of acute and chronic subjective symptoms were increased positively with the concentration of toluene in workers with normal genotype, but ho such trends were found in workers with inactive genotype. 6. The result of simple linear regression between toluene and urinary hippuric acid concentrations showed a very significant positive linear relation-ship. The mean hippuric acid concentration of nonoccupational exposure was 0.289+/-0.227 (0.062-0.516) g/l. Toluene exposure level unable to discriminate with nonoccupational exposure estimated from regression equation, it range from 7.29 to 9.87 ppm. Considering above all things, it was useful to estimate the exposure level of toluene by means of analysing urinary hippuric acid concentration in both genotype workers, but the biological exposure indices (BEI) of both genotypes were different from each other. The BEI of the total exposed workers was 2.76 g/ I, which was lower than current criteria 3.0g/ I (2.5 g/g Cr), and it also suggest that the BEI for the exposed workers in our country be lowered to the appropriate level after further study.

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Effects of Factors Associated with Urine Hippuric Acid Correction Values in Urinary Creatinine by HPLC and Jaffe Method and Specific Gravity HPLC Jaffe Method
Key-Young Kim, Jong-Gyu Kim, Ki-Nam Yoon, Wha-Me Park, Hun-Hee Park
Journal of Korean Society of Occupational and Environmental Hygiene.2015; 25(4): 493. CrossRef

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Original Article

Development of Methods to Estimate Exposure Levels to Vinyl Chloride Monomer and Multiphasic Screening Tests for Workers of Polyvinyl Chloride Manufacturing Factories: Heon Kim, Youn Jeong Nam, Sung Taek Kim, Dae Young Kim, Sul Hui Han, Kuck Tae Park; Korean Journal of Occupational and Environmental Medicine 1994;6(2):201-218. Published online September 30, 1994; DOI: https://doi.org/10.35371/kjoem.1994.6.2.201

Abstract PDF: In order to develop questionnaire estimating vinyl chloride monomer(VCM) exposure levels, to reset selection criteria for detailed tests, to measure current VCM exposure levels, to evaluate the mutagenic effects of VCM exposures and to develop multiphasic screening method of PVC- or VCM-handling workers, VCM concentrations of work environments were measured and tentative self-administrative questionnaire, physical examination, sister chromatid exchange(SCE) test and some clinical chemical test were applied to 195 men who had been handling VCM or PVC(Exposed Group) and 37, in the same factories without exposure to VCM or in polyethylene- or polypropylene-related factories(Control Group). Mean VCM concentrations of work environments were 0.268+/-0.183 ppm under PVC synthesis processes, 0.160+/-0.200 ppm under VCM synthesis process, 0.076+/-0.111 ppm under PVC pipe producing processes, 0.090+/-0.108 ppm under PVC wall paper, sheet, or film producing processes, 0.071+/-0.051 ppm under PVC floor producing processes, 0.243+/-0.250 ppm under PVC sash producing processes, and 0.020+/-0.031 ppm under triming process. VCM levels of work environments under manual resin mixing processes (0.209+/-0.168 ppm)were higher than those of the others (0.209+/-0.168 ppm) (p-value<0.05). There was no VCM-related symptoms, the positive response rates of which were higher in the Exposed Group. Overall abnormal rate in clinical chemistry test of the Exposed Group was higher than that of the Control Group, but due to extermely low exposure level of exposure group and to small sample size of the Control Group, no statistical significance was found(p-value>0.05). SCE frequencies of the Exposed Group were significantly higher than those of Contorl Group(p-value<0.05) and those of test-abnormal persons were higher than those of test-normal persons. SCE frequencies linearly increased with not only current but also cumulative VCM exposure levels(p-value<0.05). These results suggest that adverse health effect may ensue from VCM exposure to as low as 1 ppm. But SCE frequencies had no statistically significant correlation with drinking amounts, smoking amoutns, or radiation dose equivalents. Questionnaire was revised by referring to these results and formula estimating cumulative VCM exposure levels based on occupational history in questionnaire were made. In addition, were presented methods evaluating work environments and multiphasic screening test for PVC workers.

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