Neuropathy in an artist exposed to organic solvents in paints: a case study

Small-fibre polyneuropathy caused by chemical agent resistant coating

We describe a 65-year-old man who during his service in the military developed an acute onset of burning pain in his feet and hands shortly after an acute, severe exposure to the fumes of chemical agent resistant coating (CARC). This chemical is used in the military to paint vehicles and equipment to create metal surfaces resistant to corrosion and penetration by chemical agents. Extensive laboratory workup for peripheral neuropathies was unremarkable. Nerve conduction studies showed axonal-loss polyneuropathy. Skin biopsy confirmed a small-fibre polyneuropathy (SFP). His burning pain persisted over three decades and was partially controlled with tramadol. This is the first case of SFP caused by acute CARC exposure with long-term surveillance.

Ecological hazard assessment of methyl ethyl ketone using the species sensitivity distribution approach in a soil ecosystem

Methyl ethyl ketone (MEK) is a common and widely used industrial solvent. However, few studies have investigated its toxicity, or its effects as a contaminant in soil ecosystems. In this study, acute and chronic toxicity data for MEK were generated, and ecological risk based on a species sensitivity distribution was assessed. Seven soil organisms from six taxonomic groups were used for acute toxicity tests and five soil organisms from four taxonomic groups were used for chronic toxicity tests. Acute and chronic soil HC₅ (hazardous concentration for 5% of species) values for MEK were estimated as 53.04 and 2.593 mg MEK/kg dry soil, respectively. This is the first study to conduct battery testing for MEK; it specifies hazardous concentrations, warns of the need for accident preparedness, and points to serious potential hazards of MEK at various levels of the soil ecosystem which can translate into greater environmental damage with implications for human health. The specific sensitivity levels determined may serve as a benchmark for establishing soil standards and strategies for ecosystem protection in the face of accidental contamination.

Occupational Health and the Visual Arts: An Introduction

OBJECTIVE

Occupational hazards in the visual arts often involve hazardous materials, though hazardous equipment and hazardous work conditions can also be found. Occupational health professionals are familiar with most of these hazards and are particularly qualified to contribute clinical and preventive expertise to these issues.

METHODS

Articles illustrating visual arts health issues were sought and reviewed. Literature sources included medical databases, unindexed art-health publications, and popular press articles.

RESULTS

Few medical articles examine health issues in the visuals arts directly, but exposures to pigments, solvents, and other hazards found in the visual arts are well described. The hierarchy of controls is an appropriate model for controlling hazards and promoting safer visual art workplaces.

CONCLUSIONS

The health and safety of those working in the visual arts can benefit from the occupational health approach. Sources of further information are available.

Neuropsychological Symptoms among Workers Exposed to Toluene and Xylene in Two Paint Manufacturing Factories in Eastern Thailand

The study analyzed the exposure factors that may lead to neuropsychological symptoms among 92 workers who were exposed to xylene and toluene and 100 workers who were not exposed to the solvents. The airborne concentration of xylene and toluene was evaluated with personal passive badges. The levels of methyl hippuric acid and hippuric acid in urine were assessed, and interviews were performed to observe the neuropsychological symptoms that may result from exposure to the solvents. The result showed that the average concentration for the exposed group of xylene in the paint company working environment was 2.7 (SD = 2.4) ppm and the average concentration of toluene was 9.5 (SD = 10.4) ppm. The average level of methyl hippuric acid in urine was 78 (SD = 74.7) mg/g creatinine. Factors that affected the neuropsychological symptoms included the following. (1) The impact of age: the risk (adjusted odds ratio) for getting psychosomatic symptoms in persons over 40 and exposed to xylene was 9.5 and the aOR of those exposed to toluene was 8.3. (2) The impact of not providing personal protective equipment was found to be sleep disturbance; it was found that the aOR of those exposed to xylene was 3.9, and the aOR of those exposed to toluene was 4.4. In summary, periodic examination of workers by occupational physician is needed for detection of early neuropsychological effects, especially psychosomatic symptoms, and sleep disturbances.

Does diisocyanate exposure result in neurotoxicity?

CONTEXT

Diisocyanates have been associated with respiratory and dermal sensitization. Limited number of case reports, and a few case studies, media, and other references suggest potential neurotoxic effects from exposures to toluene diisocyanate (TDI), 1,6 hexamethylene diisocyanate (HDI), and methylene diisocyanate (MDI). However, a systematic review of the literature evaluating the causal association on humans does not exist to support this alleged association.

OBJECTIVE

To perform systematic review examining the body of epidemiologic evidence and provide assessment of causal association based on principles of the Sir Austin Bradford Hill criteria or considerations for causal analysis.

METHODS

A comprehensive search of public databases for published abstracts, case reports, cross-sectional surveys, and cohort studies using key search terms was conducted. Additional searches included regulatory reviews, EU IUCLID and EU Risk Assessment databases, and unpublished reports in the International Isocyanate Institute database. An expert panel consisting of physicians, toxicologists, and an epidemiologist critically reviewed accepted papers, providing examination of epidemiologic evidence of each report. Finally, the Hill criteria for causation were applied to the summative analysis of identified reports to estimate probability of causal association.

RESULTS

Twelve papers reporting exposed populations with a variety of neurological symptoms or findings suitable for analysis were identified, including eleven case or case series reports, and one cross-sectional study. Three papers reported on the same population. Each of the papers was limited by paucity of diisocyanate exposure estimates, the presence of confounding exposures to known or suspected neurotoxicants, a lack of objective biological measures of exposure or neurotoxic effects, and lack of relative strength of association measures. Additionally, reported health symptoms and syndromes lacked consistency or specificity. No plausible mechanism of toxicity was found. Application of a predictive mathematical model for determining probability of causal association for neurotoxicity was calculated to be 21%.

CONCLUSION

There is insufficient evidence for a causal association of neurotoxic effects and diisocyanate exposure based on lack of evidence in all categories of the Hill criteria for causality except for temporal association of reported symptoms and alleged exposure. Future reports should attempt to address more rigorous exposure assessment and control for confounding exposures.

Organic solvent use in enterprises in Japan

This study was initiated to elucidate possible changes in types of organic solvents (to be called solvents in short) used in enterprises in Japan through comparison of current solvent types with historical data since 1983. To investigate current situation in solvent use in enterprises, surveys were conducted during one year of 2009 to 2010. In total, workroom air samples in 1,497 unit workplaces with solvent use were analyzed in accordance with regulatory requirements. Typical use pattern of solvents was as mixtures, accounting for >70% of cases. Adhesives spreading (followed by adhesion) was relatively common in small-scale enterprises, whereas printing and painting work was more common in middle-scale ones, and solvent use for testing and research purpose was basically in large-scaled enterprises. Through-out printing, painting, surface coating and adhesive application, toluene was most common (being detected in 49 to 82% of workplaces depending on work types), whereas isopropyl alcohol was most common (49%) in degreasing, cleaning and wiping workplaces. Other commonly used solvents were methyl alcohol, ethyl acetate and acetone (33 to 37%). Comparison with historical data in Japan and literature-retrieved data outside of Japan all agreed with the observation that toluene is the most commonly used solvent. Application of trichloroethylene and 1,1,1-trichloroethane, once common in 1980s, has ceased to exist in recent years.

Avermectin intoxication with coma, myoclonus, and polyneuropathy

INTRODUCTION

Avermectin has been used in the control of parasites and insects. Severe poisoning symptoms in humans include altered mental status, hypotension, and respiratory failure.

CASE REPORT

We describe a case of acute avermectin intoxication at a very high dose (414.2 mg/kg) who presented with coma, myoclonus, and polyneuropathy after oral ingestion.

DISCUSSION

The symptoms are supposed to be associated directly with the avermectin poisoning and possibly with the toxicity of solvents or other additives.

CONCLUSION

To the best of our knowledge, this is the first case with avermectin poisoning associated with myoclonus and polyneuropathy in the literature.

Auditory neuropathy in a patient exposed to xylene: case report

OBJECTIVE

To report the case of an adult patient who developed auditory complaints following xylene exposure, and to review the literature on the effects of solvent exposure on hearing.

CASE REPORT

The patient presented with a gradual deterioration in his ability to hear in difficult acoustic environments and also to hear complex sounds such as music, over a 40-year period. His symptoms began following exposure to the solvent xylene, and in the absence of any other risk factor. Our audiological investigations revealed normal otoacoustic emissions with absent auditory brainstem responses and absent acoustic reflexes in both ears, consistent with a diagnosis of bilateral auditory neuropathy. Central test results were also abnormal, indicating possible involvement of the central auditory pathway.

CONCLUSIONS

To our knowledge, this is the first report of retrocochlear hearing loss following xylene exposure. The test results may provide some insight into the effect of xylene as an isolated agent on the human auditory pathway.

Grand rounds: could occupational exposure to n-hexane and other solvents precipitate visual failure in leber hereditary optic neuropathy?

CONTEXT

Leber hereditary optic neuropathy (LHON) is a maternally inherited loss of central vision related to pathogenic mutations in the mitochondrial genome, which are a necessary but not sufficient condition to develop the disease. Investigation of precipitating environmental/occupational (and additional genetic) factors could be relevant for prevention.

CASE PRESENTATION

After a 6-month period of occupational exposure to n-hexane and other organic solvents, a 27-year-old man (a moderate smoker) developed an optic neuropathy. The patient had a full ophthalmologic and neurologic investigation, including standardized cycloergometer test for serum lactic acid levels and a skeletal muscle biopsy. His exposure history was also detailed, and he underwent genetic testing for LHON mitochondrial DNA mutations. The patient suffered a sequential optic neuropathy with the hallmarks of LHON and tested positive for the homoplasmic 11778G--> A/ND4 mutation. Routine laboratory monitoring revealed increased concentrations of urinary 2.5 hexandione (n-hexane metabolite) and hippuric acid (toluene metabolite) in the period immediately preceding the visual loss.

DISCUSSION

In a subject carrying an LHON mutation, the strict temporal sequence of prolonged appreciable occupational exposure followed by sudden onset of visual loss must raise a suspicion of causality (with a possible further interaction with tobacco smoke).

RELEVANCE

In this article, we add to the candidate occupational/environmental triggers of LHON and highlight the need for appropriate case-control (and laboratory) studies to validate the causal effect of mixed toxic exposures.

Axonal degeneration with unusual lesions of the myelin in an occupational neuropathy

A 35-year-old man had prolonged occupational exposure to lead carboxylate, triethylbenzene, xylene, and dichloromethane, when he developed a subacute predominantly sensory neuropathy. Ultrastructural examination of a peripheral nerve biopsy showed axonal degeneration and unusual lesions of the myelin, with Schwann cell sequestration of vesicular and lamellar debris. Biochemical analysis of lead in a frozen peripheral nerve specimen revealed no significant difference between the propositus and a control. The authors were unable to find any similar peripheral nerve lesions in the literature dealing with neurotoxic chemicals. Any of the several organic solvents could have equally caused the neuropathy and may have been potentialized by the other chemicals.