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Agency for Toxic Substances and Disease Registry
Stoddard Solvent Toxicity
Case Study and Pretest
A 50-year-old man has dizziness, euphoria, and chest discomfort.
A 50-year-old Air Force major is referred to your office. He is concerned about a recent episode in which he felt dizzy and lightheaded, and had chest discomfort. The tightness on the left side of his chest lasted about 10 minutes. It did not radiate, and it was associated with some shortness of breath, but no diaphoresis. The patient is very concerned about possible cardiac illness because his brother died of a heart attack at the age of 54.
The episode described by the patient occurred during the previous weekend while he was alone in the vehicle maintenance shop working on his car. He denies any particularly strenuous activity and states that he simply changed the oil, cleaned the engine, and replaced some spark plugs. Because it was cold outside, he had the garage doors closed and the building exhaust system off. He did not run the vehicle for prolonged periods of time. He did no welding, but he used a degreasing solution several times to remove grease from his hands. He also used the degreasing solution to clean the engine. After he sprayed the solution over the engine, he started the engine briefly. The fumes burned his eyes, nose, and throat. He felt ill shortly thereafter, with the dizziness and light-headed feeling occurring just before the onset of chest discomfort. He has not had any similar episodes in the past.
The patient's last physical examination was about 1 year ago. At that time, his cholesterol level was within normal limits, but his blood sugar was mildly elevated. After he lost 15 pounds, his glucose level returned to normal. He quit smoking 5 years ago and is taking no medications. He drinks about a six-pack of beer a week. His major exercise is walking 2 to 3 miles with his wife, three times a week, and occasionally bicycle riding with his sons. His parents are in their 70s; his mother has diabetes, and his father has hypertension and angina. The patient is a supervisor in the vehicle maintenance shop at the Air Force base, where he oversees staff in inventory and shop repair. During working hours, he spends little time in the vehicle maintenance areas. His hobbies include fishing and home renovation. He lives in Air Force housing with his wife and two children; his younger son has
asthma.
The physical examination is unremarkable, except for crusting and scaling of the skin on the volar surface of the hands and wrists, which the patient has experienced several times over the last 2 years. Results of routine laboratory screening and a 12-lead electrocardiogram (ECG) are within normal limits.
- What conditions would you consider in this patient's differential diagnosis?
- What additional information would you seek during this visit?
- How will you evaluate this patient and manage the case?
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