| Grand Rounds: An Outbreak of Toxic Hepatitis among Industrial Waste Disposal Workers Hae-Kwan Cheong, Eun A Kim, Jung-Keun Choi, Sung-Bong Choi, Jeong-Ill Suh, Dae Seob Choi and Jung Ran Kim Hae-Kwan Cheong,1 Eun A Kim,2 Jung-Keun Choi,2 Sung-Bong Choi,2 Jeong-Ill Suh,3 Dae Seob Choi,4 and Jung Ran Kim5 Abstract
Context: Industrial waste (which is composed of various toxic chemicals) , changes to the disposal process, and addition of chemicals should all be monitored and controlled carefully in the industrial waste industry to reduce the health hazard to workers. Case presentation: Five workers in an industrial waste plant developed acute toxic hepatitis, one of whom died after 3 months due to fulminant hepatitis. In the plant, we detected several chemicals with hepatotoxic potential, including pyridine, dimethylformamide, dimethylacetamide, and methylenedianiline. The workers had been working in the high-vapor-generating area of the plant, and the findings of pathologic examination showed typical features of acute toxic hepatitis. Discussion: Infectious hepatitis and drug-induced hepatitis were excluded by laboratory findings, as well as the clinical course of hepatitis. All cases of toxic hepatitis in this plant developed after the change of the disposal process to thermochemical reaction–type treatment using unslaked lime reacted with industrial wastes. During this chemical reaction, vapor containing several toxic materials was generated. Although we could not confirm the definitive causative chemical, we suspect that these cases of hepatitis were caused by one of the hepatotoxic agents or by a synergistic interaction among several of them. Relevance to clinical or professional practice: In the industrial waste treatment process, the danger of developing toxic hepatitis should be kept in mind, because any subtle change of the treatment process can generate various toxic materials and threaten the workers' health. A mixture of hepatotoxic chemicals can induce clinical manifestations that are quite different from those predicted by the toxic property of a single agent. Key words: complex exposure, dimethylacetamide, hepatotoxicity, industrial waste, liver biopsy, toxic hepatitis. Environ Health Perspect 115:107–112 (2007) . doi:10.1289/ehp.8951 available via http://dx.doi.org/ [Online 18 September 2006]
Address correspondence to E.-A Kim, Center for Occupational Disease, Occupational Safety and Health Research Institute, Korea Occupational Safety and Health Agency 34-4 Gusan-dong, Bupyeong-gu, Incheon, 430-711 Korea. Telephone: 82-32-510-0910. Fax: 82-32-518-0862. E-mail: euna0@dreamwiz.com or toxneuro@kosha.net We thank S.J. Lee (Ministry of Labor) and S.-K. Kang, J.-Y. Jeong, and G.-Y. Yi [Occupational Safety and Health Research Institute, Korean Occupational Safety and Health Agency (KOSHA) ] for their participation in this survey. We also appreciate the workers with toxic hepatitis, their families, and their doctors for their devoted cooperation. This study was conducted by the Occupational Safety and Health Research Institute, KOSHA, and was an epidemiologic survey requested by the Ministry of Labor of Korea. The findings and conclusions in this report are those of the authors and do not necessarily represent the views of KOSHA. The authors declare they have no competing financial interests. Received 23 December 2006 ; accepted 18 September 2006.
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