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.

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Olga A. Molchanova, Olga G. Bogdanova, Vladimir A. Pankov, Mikhail Yu. Itygilov
Hygiene and sanitation.2023; 102(8): 836. CrossRef

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Case Report

HCFC-123-induced toxic hepatitis and death at a Korean fire extinguisher manufacturing facility: a case series: Mu Young Shin, Jong Soo Park, Hae Dong Park, Jihye Lee; Ann Occup Environ Med 2018;30:20. Published online March 28, 2018; DOI: https://doi.org/10.1186/s40557-018-0231-2

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Background

Exposure to sustained high concentrations of HCFC-123 is known to be hepatotoxic. We report two simultaneous cases of toxic hepatitis related to exposure to 2,2-dichloro-1,1,1-trifluoroethane (HCFC-123), a common refrigerant, at a Korean fire extinguisher manufacturing facility.

Case presentation

Patients A and B were men aged 21 and 22 years, respectively, with no notable medical histories. They had recently started working for a manufacturer of fire extinguishers. During the third week of their employment, they visited the emergency center of a general hospital due to fever, lack of appetite, and general weakness. At the time of their visit, they were suspected as having hepatitis due to elevated aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT), and total bilirubin levels and were hospitalized. However, as their condition did not improve, they were moved to a tertiary general hospital. After conservative treatment, one patient improved but the other died from acute hepatic failure. Assessments of the work environment showed that the short-term exposure levels of HCFC-123 for valve assembly processes were as high as 193.4 ppm. A transjugular liver biopsy was performed in patient A; the results indicated drug/toxin-induced liver injury (DILI). Given the lack of a medical history and the occupational exposure to high levels of HCFC-123, a hepatotoxic agent, the toxic hepatitis of the workers was likely related to HCFC-123 exposure.

Conclusions

Work environment assessments have not included this agent. To the best of our knowledge, we are the first to report a case of death related to HCFC-123-induced liver damage. Our findings suggest that exposure standards and limits for HCFC-123 must be developed in Korea; work environments will have to be improved based on such standards.

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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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Review

Recognition criteria for occupational cancers in relation to hepatitis B virus and hepatitis C virus in Korea: Hogil Kim, Yun Kyung Chung, Inah Kim; Ann Occup Environ Med 2018;30:6. Published online January 31, 2018; DOI: https://doi.org/10.1186/s40557-018-0217-0

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The goal of this study was to review the scientific basis for the recognition of occupational cancer, in relation to hepatitis viral infections in Korea. Most Hepatitis B virus (HBV) infections in Korea occur as vertical infections, but these are decreasing rapidly due to vaccination. Hepatitis C virus (HCV) is known to be transmitted through parenteral routes, but the transmission route is often unclear. Most occupational infections of hepatitis virus involve accidental injuries of medical institution workers while using virus-contaminated medical devices. Many cohort studies and case-control studies have consistently reported that HBV and HCV infection increases the risk of hepatocellular carcinoma (HCC) and the strength of this association is high. Non-Hodgkin’s lymphoma appears to be associated with HCV. Cholangiocarcinoma, pancreatic cancer, leukemia, and thyroid cancer are considered to be less related or unrelated to epidemiological causation. There are no uniform international specific criteria for occupational cancer caused through occupational exposure to a hepatitis virus. In establishing appropriate standards applicable to Korea, there should be sufficient consideration of latency, virus exposure levels and frequency, and other cancers, apart from HCC.

In conclusion, we recommend keeping the current specific criteria. However, if a worker is injured at work when using a sharp medical device, and HBV and HCV viral infections are confirmed through serologic tests; if the worker is diagnosed as having a chronic HBV or HCV infection, a subsequent HCC (or Non-Hodgkin’s lymphoma following chronic HCV infection) can then be considered highly related to the worker’s occupation.

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Research Article

Hepatitis B vaccination coverage and the determinants of vaccination among health care workers in selected health facilities in Lusaka district, Zambia: an exploratory study: Namwaka Mungandi, Mpundu Makasa, Patrick Musonda; Ann Occup Environ Med 2017;29:32. Published online August 10, 2017; DOI: https://doi.org/10.1186/s40557-017-0191-y

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Background

Hepatitis B is a viral infection of the liver and causes both acute and chronic disease. It is transmitted through contact with an infected person’s bodily fluids. It is an occupational hazard for healthcare workers and can be prevented by the administration of a vaccine. It is recommended that healthcare workers be vaccinated against vaccine preventable diseases including hepatitis B. The study objective was to determine the prevalence and determinants of hepatitis B vaccination among healthcare workers in selected health facilities in Lusaka.

Methods

The study took place in seven health facilities across Lusaka district in Zambia. A total sample size of 331 healthcare workers was selected of which; 90 were nurses, 88 were doctors, 86 were laboratory personnel and 67 were general workers. A self-administered structured questionnaire was given to a total of 331 healthcare workers. Investigator led stepwise approach was used to select the best predictor variables in a multiple logistic regression model and all analyses were performed using STATA software, version 12.1 SE (Stata Corporation, College Station, TX, USA).

Results

Only 64(19.3%) of the healthcare workers were vaccinated against hepatitis B, with 35 (54.7%) of these being fully vaccinated and 29 (45.3%) partially vaccinated. Analysis showed that; age of the healthcare worker, sharp injuries per year and training in infection control were the variables that were statistically significant in predicting a healthcare worker’s vaccination status.

Conclusion

It is reassuring to learn that healthcare workers have knowledge regarding hepatitis B and the vaccine and are willing to be vaccinated against it. Health institutions should bear the cost for vaccinating staff and efforts should be made for appropriate health education regarding hepatitis B infection and its prevention. Establishment of policies on compulsory hepatitis B vaccination for healthcare workers in Zambia is recommended.

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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

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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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Acute liver injury in a non-alcoholic fatty liver disease patient with chloroform exposure: a case report
Yosuke Suehiro, Takuro Uchida, Masataka Tsuge, Eisuke Murakami, Daiki Miki, Tomokazu Kawaoka, Michio Imamura, Hiroshi Aikata, Koji Arihiro, Shiro Oka
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Jong Hyun Hwang, Jung Il Kim
Annals of Occupational and Environmental Medicine.2022;[Epub] CrossRef
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Cristiano Brauner, Dvora Joveleviths, Mário R. Álvares-da-Silva, Norma Marroni, Silvia Bona, Elizângela Schemitt, Raissa Nardi
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Chronic, Recreational Chloroform-Induced Liver Injury
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Chloroform ingestion causing severe gastrointestinal injury, hepatotoxicity and dermatitis confirmed with plasma chloroform concentrations
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Case Report

A Case of Lead Poisoning due to a Mixture of Talisman Ash: Han Hui Ye, Jae Uk Jeong, Nak Joon Baek, Chang Yul Choi, Man Joong Jeon, Joon Sakong; Ann Occup Environ Med 2013;25:37-37. Published online November 28, 2013; DOI: https://doi.org/10.1186/2052-4374-25-37

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Background

Lead is a metal that has no biological function useful for the human body. In Korea, non-occupational exposure to lead has mostly occurred through taking oriental medicine. However, in this paper we report a case of lead poisoning caused by ingesting talisman material.

Case presentation

A 16-year-old male patient complained of severe abdominal pain after taking cinnabar, a talisman material. He was diagnosed with lead poisoning accompanied by acute hepatitis. We confirmed that the cinnabar the patient took contained about 10% elemental lead. After symptom management, the patients’ symptoms, liver function test results, and blood lead concentration level improved.

Conclusion

Lead poisoning can be accompanied by hepatitis, although rarely. As we have confirmed that cinnabar as a talisman material is harmful to the human body, measures to prevent its misuse are needed.

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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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Original Article

Seroprevalence of Hepatitis A in a Manufacture Workplace: Hyun Soo Kim, Chang Sun Sim, Jae Kook Yoon, Hun Lee, Cheol In Yoo; Korean Journal of Occupational and Environmental Medicine 2010;22(4):356-363. Published online December 31, 2010; DOI: https://doi.org/10.35371/kjoem.2010.22.4.356

Abstract PDF

OBJECTIVES
The prevalence of hepatitis A decreases with improved hygiene and changing lifestyle. However, hepatitis A remains a global problem causing sporadic food-borne infections. Over the past 5 years, hepatitis A incidence has increased, and 15 deaths were reported in 2009 in Korea. Concerns about hepatitis A infection have increased. We checked hepatitis A virus antibody (HAV anti-IgG) in a large manufacturing company, so that the results could be a guideline for workplace preventive plan and health policy for hepatitis A.
METHODS
We investigated the seroprevalence of HAV anti-IgG and the demographic characteristics of employee volunteer, in a company in Ulsan. In addition, we estimated those factors that affected seroprevalence of HAV anti-IgG.
RESULTS
A total of 2,719 employee volunteers were enrolled into the study. The seropositive rate of HAV anti-IgG was 69.8% (n=1,899) and, the seronegative rate was 30.2% (n=820). There were no enrolled employees under age 24 years who tested positive for HAV anti-IgG; in this group, the seropositive rate was 0.0% (n=0); in 25~29 years the rate was 3.9% (n=12) and 26.5% (n=118) in 30~34 years olds. In the 35-39 ears, 61.1% (n=203) tested HAV anti-IgG positive and 86.8% (n=256) of 40~44 years tested positive. Other group tested as follows: 96.5% (n=335) in 45~49 year olds, 98.7% (n=593) in 50~54 year olds, and 100% (n=382) in over 55 years. There was a significantly increasing tendency to test HAV anti-IgG positive according to age group. In the 34-35 year olds, the seropositive rate exceeded the seronegative rate.
CONCLUSIONS
HAV anti-IgG seropositive rate increased according to age. The result can used for guideline recommendationsand establishing hepatitis A policies.

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Case Report

A Case of Exercise-induced Rhabdomyolysis with Hepatitis: Seong Ah Kim, Sang Je Jung, Chae Yong Lee, Bong Goo Ha, Ki Soo Park; Korean Journal of Occupational and Environmental Medicine 2006;18(1):67-72. Published online March 31, 2006; DOI: https://doi.org/10.35371/kjoem.2006.18.1.67

Abstract PDF

BACKGROUND
Rhabdomyolysis is a relatively rare disease caused by various factors and is characterized by skeletal muscle damage. While crush injury is the most common cause in Korea as well as other countries, overexertion is an important common cause among young men in daily life. Although exercise-induced rhabdomyolysis is already well published among athletes or military persons, there have been few reports in workers.
CASE
REPORT: We observed a 28-year-old male worker who had elevated liver transaminases during a periodic workers' health checkup. Although he did not exhibit the typical pattern of toxic hepatitis, we had to exclude any possibility of dimethylacetamide-induced hepatitis (DIH) because he had worked in a spandex-producing factory, which already had a history of many DIH cases over several years. We performed careful history taking, several laboratory tests, liver ultrasonography and liver biopsy. We also investigated the results of biological monitoring and air concentrations of dimethylacetamide. The findings from these examinations supported the clinical diagnosis of exercise-induced rhabdomyolysis with hepatitis.
CONCLUSION
This case demonstrates that exercise can induce rhabdomyolysis and hepatitis. This disease must be treated by prompt and appropriate management because it might develop more serious complications such as acute renal failure.

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Case Report

A Case of Acute Toxic Hepatitis induced by brief exposure to Dimethylformamide: Jong Rae Roh, Jin Gun Sohn, Jin Ha Kim, Sun Ja Park; Korean Journal of Occupational and Environmental Medicine 2005;17(2):144-148. Published online June 30, 2005; DOI: https://doi.org/10.35371/kjoem.2005.17.2.144

Abstract PDF

Dimethylformamide (DMF), a widely used industrial solvent, has been reported to induce subtle to clinically overt hepatotoxicity. Liver injury due to occupational exposure through inhalation and skin contact has been sporadically reported. We report a 23-year-old male who developed intermittent abdominal pain, anorexia, nausea, vomiting, chest discomfort, and general weakness for 4 days after working in a plastic-coated-glove factory. An acute hepatitis episode occurred after working in an enclosed workplace for 3 days. Other causes of hepatitis such as viral, drug induced or alcoholic hepatitis, could be excluded or were considered to be unlikely. Based on occupational history, serological examination and serial liver function examinations, the case was compatible with DMF-induced acute toxic hepatitis. Hepatotoxicity due to occupational exposure to solvents (e.g., DMF) should be considered in any patient with unexplained hepatitis. The fast improvement of the clinical symptoms and the progressive normalization of the liver function tests once the DMF exposure has been stopped, supports the diagnosis.

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Case Report

A Case of Toxic Hepatitis in a Worker Exposed to a Cleansing Agent Mainly Composed of Methylene Chloride: Bong Goo Ha, Jin Seok Kim, Jay Young Yu, Kuck Hyun Woo, Jung Oh Ham, Seong Yong Yoon, Yong Seok Jang, Sang Je Jung; Korean Journal of Occupational and Environmental Medicine 2004;16(2):210-219. Published online June 30, 2004; DOI: https://doi.org/10.35371/kjoem.2004.16.2.210

Abstract PDF

OBJECTIVES
To report a case of toxic hepatitis in a worker exposed to a cleansing agent mainly composed of methylene chloride.
METHODS
A 27-year-old female worker who had worked in an inspection and packing position of semiconductor parts in a factory using methylene chloride as a metal cleansing solvent was hospitalized due to fever, chill and generalized aches. We evaluated her with blood tests, abdominal ultrasonographic scan and abdominal CT scan and also took her occupational history.
RESULTS
The patient showed acute hepatitis in blood and radiologic tests after admission. The serologic tests for viral hepatitis A, B, C and autoimmune hepatitis were negative. She had no history of significant alcohol use, recent medication or drug allergy. After admission, her symptoms were improved and liver enzyme levels(AST and ALT) were markedly reduced. She returned to her workplace after discharge. Thereafter, however, her previous symptoms were recurred and she was hospitalized again 2 days after returning to her workplace. After this second admission, she showed acute hepatitis in blood tests and her symptoms were improved and liver enzyme levels were markedly reduced with the same pattern as those of the first admission. On the 11th day of the second admission, liver enzyme levels were normalized and she was discharged from hospital.
CONCLUSIONS
We presume that this patient`s liver injury was related to the methylene chloride presence at her workplace due to her clinical symptoms, blood tests, radiologic tests and occupational history.

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Death Due to Acrylic Adhesive (Dichloromethane): A Case Report
Ho Bong Hyun, Jo Youn Park, Hyeong Sin Park, Jeong Hyun Hong, Myung Guon Ko, Hyun Wook Kang, Hyoung Soo Lim
Korean Journal of Legal Medicine.2022; 46(4): 133. 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
Occupational Hepatic Disorders in Korea
Hyoung Ryoul Kim, Tae Woo Kim
Journal of Korean Medical Science.2010; 25(Suppl): S36. CrossRef

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Case Report

Exfoliative Dermatitis and Toxic Hepatitis Associated with Occupational Exposure to Trichloroethylene: Hong Jae Chae, Seong Kwan Lee, Kang Jin Lee, Jong Youl Kim, Seung Chul Lee, Dong Hyeon Shin, Jai Dong Moon; Korean Journal of Occupational and Environmental Medicine 2003;15(1):111-117. Published online March 31, 2003; DOI: https://doi.org/10.35371/kjoem.2003.15.1.111

Abstract PDF

A 28-year-old male began working as a degreaser. The solvent used in the degreasing operation was trichloroethylene. Over the next month the man experienced fever, chills, and an erythematous skin rash and itching. At that time he had a marked elevation in his liver enzyme, with cholestasis. Over the next few days the rash persisted then peeled. There was an elevation of Ig E, and a positive patch test reaction to trichloroethylene. His dermatitis and hepatitis were considered to be mediated by a hypersensitivity mechanism.

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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
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
Follow-up assessment of two cases of trichloroethylene hypersensitivity syndrome: A case report
Yong-Shun Huang, Han-Lin Huang, Qi-Feng Wu, Li-Hua Xia, Ming Huang, Xin-Xiang Qiu, Shan-Yu Zhou
Experimental and Therapeutic Medicine.2016; 12(2): 895. CrossRef
Trichloroethylene Hypersensitivity Syndrome Is Potentially Mediated through Its Metabolite Chloral Hydrate
Yongshun Huang, Lihua Xia, Qifeng Wu, Zifang Zeng, Zhenlie Huang, Shanyu Zhou, Jiachun Jin, Hanlin Huang, Edda Fiebiger
PLOS ONE.2015; 10(5): e0127101. CrossRef
Severe acute hepatitis in a printing company worker: A case study
Shoji Kubo, Koichi Matsuzaki, Toshihito Seki, Masahiko Ohsawa, Shinji Kumagai, Ginji Endo
Journal of Occupational Health.2015; 57(1): 87. CrossRef
Trichloroethylene Hypersensitivity Syndrome: A Disease of Fatal Outcome
Hyun Gul Jung, Hyung Hun Kim, Bong Gun Song, Eun Jin Kim
Yonsei Medical Journal.2012; 53(1): 231. CrossRef
Hypersensitivity syndrome due to trichloroethylene exposure: A severe generalized skin reaction resembling drug‐induced hypersensitivity syndrome
Hideaki WATANABE
The Journal of Dermatology.2011; 38(3): 229. CrossRef
Occupational Skin Diseases in Korea
Yeon-Soon Ahn, Min-Gi Kim
Journal of Korean Medical Science.2010; 25(Suppl): S46. CrossRef
Occupational Hepatic Disorders in Korea
Hyoung Ryoul Kim, Tae Woo Kim
Journal of Korean Medical Science.2010; 25(Suppl): S36. CrossRef
Occupational trichloroethylene exposure as a cause of idiosyncratic generalized skin disorders and accompanying hepatitis similar to drug hypersensitivities
Michihiro Kamijima, Naomi Hisanaga, Hailan Wang, Tamie Nakajima
International Archives of Occupational and Environmental Health.2007; 80(5): 357. CrossRef

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Original Article

Toxic Hepatitis Induced by Occupational Dimethylacetamide Exposure: Tae Sung Choi, Kuck Hyeun Woo, Jin Seok Kim, Wan Seup Park, Jung Ho Ham, Sang Je Jung, Jae Young Yu; Korean Journal of Occupational and Environmental Medicine 2001;13(2):164-170. Published online June 30, 2001; DOI: https://doi.org/10.35371/kjoem.2001.13.2.164

Abstract PDF

Dimethylacetamide is widely used in the production of plastics, resins, synthetic fibers, and gums and in purification and crystallization processes. Inhalation of the vapor or skin absorption of the liquid of dimethylacetamide(DMAC) can cause liver damage. Toxic hepatitis possibly attributable to DMAC exposure occurred in seven works among 178 employees who had worked on a new spandex-fiber production line. A large amount of DMAC is used as a spinning solvent for synthetic fibers in the factory. The patients were aged 23-47 years old and composed of five males and two females. They were involved in the process of polymerization(1 patient), spinning(1), take-up(4) and packaging(1). The mean duration of exposure was 10 weeks. They experienced fatigue, dizziness and jaundice. The patients showed elavated total bilirubin, alanine aminotransferase(ALT), and aspartate aminotransferase(AST) levels. The serologic test for viral hepatitis A, B and C were negative, as were the abdominal ultrasonographic scans. Based on the presumptive diagnosis of DMAC-induced toxic hepatitis, they were removed from the workplaces. One or two months after removal from the work, the transaminase levels returned to normal. The patients had no history of significant alcohol use, blood transfusion, recent medication, and drug abuse. As a result, authors could not find any attributable cause of toxic hepatitis but the toxicity by DMAC exposure.

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Intravenous Busulfan, Dimethylacetamide and neurotoxicity after high-dose pretransplant conditioning chemotherapy
J. Ramdial, K. H. Chan, G. Sanchez Petitto, B. Valdez, B. S. Andersson, Y. Nieto
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A green approach to porous and dense antifouling membranes through solvent-free bulk polymerization
Runnan Zhang, Jinming Peng, Yanlei Su, Xiaochen Fan, Zhongyi Jiang, Xueting Zhao, Jiazhen Liu, Yafei Li, Jiaojiao Zhao
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Grand Rounds: An Outbreak of Toxic Hepatitis among Industrial Waste Disposal Workers
Hae-Kwan Cheong, Eun A Kim, Jung-Keun Choi, Sung-Bong Choi, Jeong-Ill Suh, Dae Seob Choi, Jung Ran Kim
Environmental Health Perspectives.2007; 115(1): 107. CrossRef
Incidence of dimethylacetamide induced hepatic injury among new employees in a cohort of elastane fibre workers
C-Y Lee, S-J Jung, S-A Kim, K-S Park, B-G Ha
Occupational and Environmental Medicine.2006; 63(10): 688. CrossRef

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Original Article

A Survey of Hepatitis B Virus Markers by EIA Method among Steel Manufacturing Workers: Jung Gu Kirn, Bbk Dong Nam, Sam Deug Bae, Myung Wha Ha, Doo Hie Kim, Seung Won Kang, Jong Young Lee; Korean Journal of Occupational and Environmental Medicine 1996;8(2):249-257. Published online September 30, 1996; DOI: https://doi.org/10.35371/kjoem.1996.8.2.249

Abstract PDF: A study for seroprevalence of Hepatitis B virus markers (HBsAg, Anti-HBs, HBeAg and Anti-HBe) by EIA method and the Liver Function Test(SGOT and SGPT) using kinetic method was carried :out from January; to October 1995 :among male workers of a .major iron and steel manufacturing company, located,,in Pohang. The results were as follows; 1. The distribution of hepatitis B virus markers showed that the proportions of HBsAg(+)/Anti-HBs (-), HBsAg(-)/Anti-HBs (+) 'and HBsAg(+)/Anti-HBs (+) were 8.1%, 60.5% and 0.1%, respectively. The positive rate of HBsAg in all subjects was 8.2% whereas that of anti-HBs was 60.6%. 2. The proportions of HBsAg(+)/Anti-HBs (-) and HBsAg(-)/Anti-HBs (+) increased significantly with age. While the distribution of hepatitis B virus markers exhibited no significant differences among the groups classified by educational background or work type. 3. The proportion of drinkers in HBsAg (+)/Anti-HBs (-) (73; 9%) was significantly lower than those of HBsAg (-)/Anti-HBs (-) and HBsAg (-)/Anti-HBs (+) (84.6% and 85.7% respectively). The proportions of smoking for the three groups of HBsAg (-)/Anti-HBs(+),-HBsAg (+)/Anti-HBs (-) and HBsAg (-)/Anti-HBs (-) were 54.3%, 53.7% and 53.0%, respectively (p<0.01). The proportion of the subjects with abnormal liver function test in HBsAg (+)/Anti-HBs (-) was 40.1%, whereas those in HBsAg (-)/Anti-HBs (-) and HBsAg(-)/Anti-HBs (+) were 21.9% and 18.4%, respectively. 4. The distribution of e Ag markers among HBsAg (+) subjects showed that the proportions of HBeAg(+)/Anti-HBe(-), HBeAg(-)/Anti-HBe(+) and HBeAg(+)/Anti-HBe(+) were 31.3%, 55.0% and 1.6%, respectively. The proportion of HBeAg(+)/Anti-HBe(-) decreased significantly with age and those of HBeAg(-)/Anti-HBe(-) and HBeAg(-)/Anti-HBe(+) increased with age. The positive rate of HBeAg among HBsAg (+) subjects was 32.9%. In conclusion, as a screening method, EIA is. recommended to test hepatitis B virus markers, especially when examining Anti-HBs more sensitively. For the workers of the iron and steel manufacturing company studied, liver diseases caused by other than hepatitis B should be given a special care including an education avoiding alcohol drinking.

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