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Wang Y, Du P. Acute organic solvent toxic encephalopathy: A case report and literature review. Biomed Rep 2024; 21:163. [PMID: 39268402 PMCID: PMC11391175 DOI: 10.3892/br.2024.1851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Accepted: 08/05/2024] [Indexed: 09/15/2024] Open
Abstract
Organic solvents are a class of volatile, lipophilic substances that can easily enter the human body through skin and mucous membrane contact as well as air inhalation, and can lead to toxic encephalopathy (TE), especially after entering the lipid-rich nervous system. The present case reports a patient with acute organic solvent toxic encephalopathy (AOSTE), which may have been caused by occasional ink leakage from Xuzhou (Jiangsu, China). By summarizing the history the patient to exposure to organic solvents, clinical manifestations, radiology findings and relevant laboratory tests, we hypothesize that a history of ink exposure, brain magnetic resonance imaging findings and hippuric acid testing were indispensable factors in the diagnosis of AOSTE. After neurological treatment, the patient experienced notable improvement in symptoms. The present study reports on its clinical features, imaging features, treatment and follow-up, and review relevant literature to summarize its clinical experience, hoping to improve our understanding of AOSTE.
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Affiliation(s)
- Yinjiao Wang
- Department of Radiology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221000, P.R. China
| | - Peng Du
- Department of Radiology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221000, P.R. China
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Eden CO, Alkhalaileh DS, Pettersson DR, Hunter AJ, Arastu AH. Clinical and neuroradiographic features of fentanyl inhalation-induced leukoencephalopathy. BMJ Case Rep 2024; 17:e258395. [PMID: 38684340 PMCID: PMC11103052 DOI: 10.1136/bcr-2023-258395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2024] [Indexed: 05/02/2024] Open
Abstract
A man in his late 40s with no known past medical history was unresponsive for an unknown period of time. Crushed pills and white residue were found on a nearby table. On presentation he was obtunded and unresponsive to verbal commands but withdrawing to painful stimuli. The initial urine drug screen was negative, but a urine fentanyl screen was subsequently positive with a level of 137.3 ng/mL. MRI of the brain showed reduced diffusivity and fluid attenuated inversion recovery (FLAIR) hyperintensity symmetrically in the bilateral supratentorial white matter, cerebellum and globus pallidus. Alternative diagnoses such as infection were considered, but ultimately the history and workup led to a diagnosis of fentanyl-induced leukoencephalopathy. Three days after admission the patient became able to track, respond to voice and follow basic one-step commands. The patient does not recall the mechanism of inhalation. While there are case reports of heroin-induced leukoencephalopathy following inhaled heroin use and many routes of fentanyl, this is the first reported case of a similar phenomenon due to fentanyl inhalation.
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Affiliation(s)
- Christopher O Eden
- Department of Internal Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Duna S Alkhalaileh
- Department of Internal Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - David R Pettersson
- Department of Diagnostic Radiology, Oregon Health & Science University, Portland, OR, USA
| | - Alan J Hunter
- Department of Internal Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Asad H Arastu
- Department of Internal Medicine, Oregon Health & Science University, Portland, Oregon, USA
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Li C, Hu J, Su H. Two cases reports: Severe liver injury caused by 1,2,3-trichloropropane poisoning. Front Public Health 2023; 11:1171071. [PMID: 37124800 PMCID: PMC10140538 DOI: 10.3389/fpubh.2023.1171071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 03/27/2023] [Indexed: 05/02/2023] Open
Abstract
Background 1,2,3-trichloropropane (TCP) poisoning can induce liver damage in humans and animals, but reports of severe liver injury and its histology are rare. We presented two cases of 1,2,3-TCP inhalation poisoning resulting in severe liver injury confirmed by exposure history, toxicology, biochemical index and pathology. Case description Two young male presented acute poisoning process with mild to moderate early symptoms, and developed severe jaundice and coagulation dysfunction after exposure to 1,2,3-TCP. The total bilirubin (TBIL) in case 1 and case 2 reached the peak value of 635.8 μmol/L and 437.1 μmol/L on the 25th and 22nd days, respectively. Their liver enzymes and international normalized ratio increased rapidly to peak and fell back, and TBIL remained at a high level. 1,2,3-TCP was detected in their blood, and their liver histology indicated severe necrosis of hepatocytes, infiltration of massive inflammatory cells, and cholestasis. They all finally recovered after a long time of treatment. Conclusion The two cases in this study demonstrate that 1,2,3-TCP inhalation poisoning without any protective measures can induce severe liver injury in humans.
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Affiliation(s)
| | - Jinhua Hu
- *Correspondence: Jinhua Hu, ; Haibin Su,
| | - Haibin Su
- *Correspondence: Jinhua Hu, ; Haibin Su,
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Chen J, Cheng B, Xie W, Su M. Occupational Dust Exposure and Respiratory Protection of Migrant Interior Construction Workers in Two Chinese Cities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:113. [PMID: 36011748 PMCID: PMC9408467 DOI: 10.3390/ijerph191610113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 02/05/2023]
Abstract
Migrant interior construction workers are increasing in China. Construction workers are at an increased risk of work-related illness (WRI) due to prolonged exposure to and inhalation of dust. Dust concentrations in the air can be reduced significantly with effective respiratory protection measures. We assessed the dust exposure and factors associated with respiratory protection of migrant interior construction workers. The total dust concentration in the workplace ranged from 0.07 to 335.27 mg/m3, with a total dust exceedance rate of 50.00%. The respiratory dust loading ranged from 0.03 to 220.27 mg/m3, with a respiratory dust exceedance rate of 71.42 %. The highest total dust concentration occurred when masons were polishing cement walls. We performed a questionnaire survey of 296 persons in two cities in China, in which 87.84% had no respiratory protection or only one protection measure. Gender, workplace, respiratory disease, and protective attitude all had an effect on the level of respiratory protection. The dust exposure in most jobs exceeds hygiene standards. The respiratory protection of migrant interior construction workers in China is inadequate.
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Affiliation(s)
- Jinfu Chen
- Department of Pathology, Guangdong Provincial Key Laboratory of Infectious Diseases and Molecular Immunopathology, Shantou University Medical College, Shantou 515041, China
- MPH Education Center, Shantou University Medical College, 22 Xin Ling Road, Shantou 515041, China
| | - Bowen Cheng
- Department of Pathology, Guangdong Provincial Key Laboratory of Infectious Diseases and Molecular Immunopathology, Shantou University Medical College, Shantou 515041, China
- MPH Education Center, Shantou University Medical College, 22 Xin Ling Road, Shantou 515041, China
| | - Wei Xie
- Department of Pathology, Guangdong Provincial Key Laboratory of Infectious Diseases and Molecular Immunopathology, Shantou University Medical College, Shantou 515041, China
- MPH Education Center, Shantou University Medical College, 22 Xin Ling Road, Shantou 515041, China
| | - Min Su
- Department of Pathology, Guangdong Provincial Key Laboratory of Infectious Diseases and Molecular Immunopathology, Shantou University Medical College, Shantou 515041, China
- Correspondence: ; Tel./Fax: +86-0754-8890-0429
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Wen Z, Dai P, Zhou Z, Guo L, Zhang T, Genjiafu A, Jian T, Li Y, Kan B, Jian X. Case Report: Toxic encephalopathy caused by repeated inhalation of liquid sealant. Front Public Health 2022; 10:920310. [PMID: 35991034 PMCID: PMC9389144 DOI: 10.3389/fpubh.2022.920310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 07/22/2022] [Indexed: 11/13/2022] Open
Abstract
Short-term exposure to high levels of organic solvents, as well as long-term exposure to small doses, can damage the central nervous system, thereby leading to toxic encephalopathy. However, toxic encephalopathy caused by long-term inhalation of liquid sealant is rarely reported. This study describes the clinical data of a case of toxic encephalopathy caused by repeated inhalation of liquid sealants and discusses the pathophysiological characteristics and treatment of organic solvent toxic encephalopathy. This report aims to strengthen the understanding of this disease among clinical staff.
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Affiliation(s)
- Zixin Wen
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Poisoning and Occupational Diseases, Emergency Medicine, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Ping Dai
- Department of Poisoning and Occupational Diseases, Emergency Medicine, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Zhiqiang Zhou
- Department of Poisoning and Occupational Diseases, Emergency Medicine, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, China
- School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Lanlan Guo
- Department of Poisoning and Occupational Diseases, Emergency Medicine, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, China
- School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Tongyue Zhang
- Department of Poisoning and Occupational Diseases, Emergency Medicine, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Aerbusili Genjiafu
- Department of Poisoning and Occupational Diseases, Emergency Medicine, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, China
- School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Tianzi Jian
- Department of Poisoning and Occupational Diseases, Emergency Medicine, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yaqian Li
- Department of Poisoning and Occupational Diseases, Emergency Medicine, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Baotian Kan
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Geriatric Medicine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- *Correspondence: Baotian Kan
| | - Xiangdong Jian
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Poisoning and Occupational Diseases, Emergency Medicine, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, China
- Xiangdong Jian
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Yoon JH, Seo HS, Lee J, Moon C, Lee K. Acute high-level toluene exposure decreases hippocampal neurogenesis in rats. Toxicol Ind Health 2016; 32:1910-1920. [DOI: 10.1177/0748233715599087] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Toluene is an organic solvent that is used in various industrial applications. Despite its usefulness, toluene has toxic effects on the brain and is a substance that is commonly abused. Toluene causes behavioral and functional abnormalities such as decreased memory capacity, cognitive impairment, and depression-like symptoms. However, the target sites and toxic mechanisms of inhaled toluene in the brain are poorly understood. In this study, we subjected Sprague-Dawley (SD) rats to acute high-level toluene exposure (7000 ppm) to investigate its neuronal toxicity, and in particular, its effect on neurogenesis in the hippocampus. In order to assay the effects of inhaled toluene on hippocampal neurogenesis, we measured the levels of neurogenesis markers Ki-67 and doublecortin (DCX) in the hippocampus 1, 2, 5, and 8 days after cessation of toluene exposure. In addition to assaying clinical signs, body weight, and bronchoalveolar lavage fluid, the liver, lungs, and kidneys were subjected to histopathological examination to investigate the toxic effects of high-level toluene exposure. Although abnormal neurological signs were observed after toluene exposure, these disappeared within 24 h and no toluene-related toxicological effects were observed in the liver, lungs, or kidneys. The animals exposed to toluene showed significantly decreased hippocampal neurogenesis, which persisted until the 8th and final day of measurement. Thus, acute high-level toluene exposure inhibited hippocampal neurogenesis and produced transient abnormal neurological signs, but did not produce toxicity in the other organs studied.
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Affiliation(s)
- Jin-ha Yoon
- The Institute for Occupational Health, Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Heung-Sik Seo
- Inhalation Toxicology Research Center, Korea Institute of Toxicology, Jeonbuk, Korea
- Toxicity Evaluation Team, Healthcare Research Institute, Korea Testing & Research Institute, Hwasun, Korea
| | - Jinsoo Lee
- Inhalation Toxicology Research Center, Korea Institute of Toxicology, Jeonbuk, Korea
| | - Changjong Moon
- Department of Veterinary Anatomy, Chonnam National University, Gwangju, Korea
| | - Kyuhong Lee
- Inhalation Toxicology Research Center, Korea Institute of Toxicology, Jeonbuk, Korea
- Human and Environment Toxicology, University of Science and Technology, Daejeon, Korea
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Occupation and the risk of chronic toxic leukoencephalopathy. HANDBOOK OF CLINICAL NEUROLOGY 2015; 131:73-91. [PMID: 26563784 DOI: 10.1016/b978-0-444-62627-1.00006-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Among the hundreds of environmental insults capable of inducing nervous system injury, a small number can produce clinically significant damage to the brain white matter. The use of magnetic resonance imaging (MRI) in affected individuals has greatly illuminated this previously obscure area of neurotoxicology. Toxic leukoencephalopathy has acute and chronic forms, in both of which cognitive dysfunction is the major clinical manifestation. Chronic toxic leukoencephalopathy (CTL) has been most thoroughly described in individuals with intense and prolonged exposure to leukotoxins, but the consequences of lesser degrees of exposure are not well understood. Rare cases of CTL have been reported in workers exposed to culpable leukotoxins, but study of this syndrome is hindered by many confounds such as uncertain level of toxin exposure, the presence of multiple toxins, vague dose-response relationship, comorbid medical or neurologic disorders, psychiatric illness, and legal issues. The risk of CTL in workers is low, although it is not possible to determine quantitative risk estimates. More knowledge can be expected with the application of advanced MRI techniques to the assessment of workers who may have been exposed to known or potential leukotoxins. Preventive measures for avoiding workplace CTL will be informed by clinical assessment involving the use of advanced neuroimaging and neuropsychologic evaluation in combination with accurate measurement of leukotoxin exposure.
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