Annals of Occupational and Environmental Medicine

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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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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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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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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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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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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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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