신경정신증상을 동반한 트리클로로에틸렌 중독 1예 (A Case of Trichloroethylene Intoxication with Neuropsychiatric Symptoms)

서지정보

· 발행기관 : 대한직업환경의학회
· 수록지 정보 : Annals of Occupational and Environmental Medicine / 20권 / 1호 / 54 ~ 61페이지
· 저자명 : 김자현, 김병권, 김해준, 유성진, 전형준, 박종태

초록

Background: Trichloroethylene (TCE) has been widely used as a typewriter correction fluid, paint
remover, adhesive, spot removers and, particularly, as a degreasing agent in metal-fabricating operation.
However, few studies have reported on the effects of TCE intoxication, in spite of numerous occupational
accidents arising from TCE intoxication, even until quite recently used in small companies. TCE
affects mainly the central nervous system (CNS) and is carcinogenic, even when carefully used and managed.
Case report: A 48-year-old male worker visited our hospital complaining of decreased motivation and
general weakness. In history taking, the patient had suffered insomnia, memory disturbance, stuttering,
loss of interest and sexual desire, depressive mood for 4 years, dysesthesia with tingling sensation and
pain in both extremities, and a nauseas feeling similar to a hangover which had been aggravated for 4
months before admission. The patient had been engaged in metal degreasing with TCE for 8 years.
Electromyography indicated disturbance of autonomic function, but there was neither peripheral neuropathy
nor cervical radiculopathy. Organic abnormalities including cerebellar atrophy and CNS infection
were ruled out, while there was no indication of malignancy in magnetic resonance imaging (MRI) and
metabolic disorders and electrolyte imbalances in laboratory test. The authors performed biological monitoring
for the possible exposed chemicals. Urinary 2,5-hexanedione, a metabolite of n-hexane, was
undetected but 3,331.1 mg/g creatinine of urinary trichloro-compounds, a metabolite of TCE, was detected.
The patient was diagnosed as TCE intoxication due to a level of urinary trichloro-compounds in
excess of the normal range (300 mg/g creatinine), in addition to an occupational history and clinical
symptoms. TCE exposure was stopped in admission and the neuropsychiatric symptoms of the patient
were improved as the urinary trichloro-compounds were decreased from 3,331.1 mg/g creatinine to 64.6
mg/g creatinine in 5 days.
Conclusion: Low-dose, chronic TCE intoxication shows neuropsychiatric symptoms, which are often
misrecognized merely as a psychiatric disorder; its appropriate diagnosis, early treatment and exposure
assessment are therefore difficult. The neuropsychiatric symptoms in workers who have been exposed to
TCE should be monitored, detailed job history should be taken and biological monitoring should be conducted
to gain early insight of chronic TCE exposure.

영어초록

Background: Trichloroethylene (TCE) has been widely used as a typewriter correction fluid, paint
remover, adhesive, spot removers and, particularly, as a degreasing agent in metal-fabricating operation.
However, few studies have reported on the effects of TCE intoxication, in spite of numerous occupational
accidents arising from TCE intoxication, even until quite recently used in small companies. TCE
affects mainly the central nervous system (CNS) and is carcinogenic, even when carefully used and managed.
Case report: A 48-year-old male worker visited our hospital complaining of decreased motivation and
general weakness. In history taking, the patient had suffered insomnia, memory disturbance, stuttering,
loss of interest and sexual desire, depressive mood for 4 years, dysesthesia with tingling sensation and
pain in both extremities, and a nauseas feeling similar to a hangover which had been aggravated for 4
months before admission. The patient had been engaged in metal degreasing with TCE for 8 years.
Electromyography indicated disturbance of autonomic function, but there was neither peripheral neuropathy
nor cervical radiculopathy. Organic abnormalities including cerebellar atrophy and CNS infection
were ruled out, while there was no indication of malignancy in magnetic resonance imaging (MRI) and
metabolic disorders and electrolyte imbalances in laboratory test. The authors performed biological monitoring
for the possible exposed chemicals. Urinary 2,5-hexanedione, a metabolite of n-hexane, was
undetected but 3,331.1 mg/g creatinine of urinary trichloro-compounds, a metabolite of TCE, was detected.
The patient was diagnosed as TCE intoxication due to a level of urinary trichloro-compounds in
excess of the normal range (300 mg/g creatinine), in addition to an occupational history and clinical
symptoms. TCE exposure was stopped in admission and the neuropsychiatric symptoms of the patient
were improved as the urinary trichloro-compounds were decreased from 3,331.1 mg/g creatinine to 64.6
mg/g creatinine in 5 days.
Conclusion: Low-dose, chronic TCE intoxication shows neuropsychiatric symptoms, which are often
misrecognized merely as a psychiatric disorder; its appropriate diagnosis, early treatment and exposure
assessment are therefore difficult. The neuropsychiatric symptoms in workers who have been exposed to
TCE should be monitored, detailed job history should be taken and biological monitoring should be conducted
to gain early insight of chronic TCE exposure.

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