Two Cases Of Occupational Medicamentosa-Like Dermatitis Induced By Trichloroethylene And Literature Review

Objective Analysis clinical characteristics of Occupational Medicamentosa-like Dermatitis induced by Trichloroethylene (OMDT), investigate the methods how to deal with the disease, analysis the of the disease, in order to assist the diagnosis and treatment of the disease.Methods Clinical data of 2 cases diagnosed with OMDT were analyzed retrospectively. Retrieval reported cases and trials of TCE-induced drug eruption-like dermatitis that published in the database of CNKI and Pubmed at home and abroad. at OMDT the same time, analysis 158 cases which recorded more detailed information reported on the disease in the past 15 years, and collect the general information such as sex, age, clinical manifestations, and then analysis the pathogenesis, clinical manifestations, laboratory tests. so we can analysis the risk population, the clinical manifestations, complications, treatment methods, prognosis of OMDT.Results Trichloroethylene (TCE) was widely used in industrial as an organic solvent. However, some cases were reported that it induced skin or liver injury. Rash, fever, liver damage and enlarged lymph nodes were features in patients suffer from TCE-induced drug eruption-like dermatitis. In rare cases, it leaded to death. It is widely accepted to be an allergy disease. Its predisposing factor still needs further study. Corticosteroid played a significant role in therapy. There is also no gold standard for the treatment of this disease.We reported 2 cases diagnosed with TCE-induced drug eruption-like dermatitis. One patient presented with toxic epidermal necrolysis. The other patient presented with exfoliative dermatitis complicated with liver injury, epileptic seizures and lung infection. Both two patients were cured and discharged. We review the literature of reported 46 cases of patients,25 cases of mail,21 cases of female. The age varied from 15 to 43 years, and average was 22.9 years. Most cases distributed in Guangdong Province. The latent period ranged from 8 to 48 days, and average was 25.6 days. we find out 43 patients suffered from fever,11 with respiratory symptom and 18 with gastrointestinal symptom. All patients were suffered from dermatitis,20 cases (45%) with exfoliative dermatitis,9 cases (20%) with polymorphous erythema,2 cases (4.4%) with serious polymorphous erythema and 2 case (4.4%) with toxic epidermal necrolysis,43 cases (94.9%) with activity increasing of ALT or AST,14 cases with myocardial disorder. Glucocorticoid is the most important therapy. glucocorticoid pulse, Intravenous immunoglobulin and plasmapheresis can also be available for some OMDT patient. Complications, for instance, infection and diabetes, were common in these cases.8 deaths was included in these cases.Conclusions1. Occupational Medicamentosa-like Dermatitis by Trichloroethylene (OMDT) has the similar pathogenesis and clinical characteristics with severe drug eruption, especially DIHS. both diagnosis and treatment of drug eruption is worth in OMDT.2. OMDT is distributed in people with 15-25 years of age. Individual genetic susceptibility is obvious, associated with HLA genes, metabolic enzyme gene.3. Besides the skin lesions, OMDT is also accompanied with liver, kidney, heart and nervous system systemic damage. Diagnosis of OMDT relies on exposure history and clinical manifestations.4. High-dose glucocorticoid therapy is the first-line of OMDT management, Skin and viscera damage is significant for deciding hormone dosage. Intravenous immunoglobulin and plasmapheresis can also be available.5. OMDT has high complication rates, and multiple organ failure and severe infection is the leading cause of death.