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Liver disease associated with occupational exposure to the solvent dimethylformamide.
Ann Intern Med. 1988 May; 108(5):680-6.AIM

Abstract

STUDY OBJECTIVE

to characterize an outbreak of liver disease among workers in a fabric coating factory; and to determine the outbreak's cause and natural history and strategies for clinical recognition, treatment, and prevention.

DESIGN

clinical-epidemiological investigation.

SETTING

academic medical center, Occupational Medicine Clinic, and worksite.

PATIENTS

fifty-eight of sixty-six workers participated in the study. All had standard liver function tests at least once. Forty-six workers completed a questionnaire; 27 had more extensive clinical evaluation for recognized liver abnormalities.

RESULTS

a plant-wide outbreak of liver disease was recognized after a new employee presented with signs and symptoms of hepatitis. Evaluation of the worksite showed that dimethylformamide, a widely used industrial solvent and known hepatotoxin, was being used to coat fabric in poorly ventilated areas without appropriate skin protection. No other major hepatotoxic exposure was identified. Overall, 36 of 58 (62%) workers tested had elevations of either aspartate aminotransferase (AST) or alanine aminotransferase (ALT) levels. Enzyme abnormalities occurred almost exclusively in production workers (35 of 46 were abnormal), whereas only 1 of 12 nonproduction workers showed any elevations in enzyme levels (P less than 0.0001). Serologic tests excluded known infectious causes of hepatitis in all but 2 workers and changes characteristic of toxic liver injury were confirmed by histologic examinations of biopsy specimens from 4 workers. The ratio of AST to ALT levels was one or less in all but 1 worker. After modification of work practices and removal of workers most severely affected from exposure, improvement in liver enzyme abnormalities and symptoms in most patients were seen, although some patients showed persistent elevations of enzyme levels.

CONCLUSIONS

an outbreak of toxic liver disease has been associated with exposure to dimethylformamide in the workplace. The diagnosis of toxic liver disease was established by the clinical histories, negative viral serologies, an enzyme pattern of ALT levels being greater than AST levels, epidemiologic data on coworkers, and liver biopsy specimens. The high prevalence of unsuspected liver enzyme abnormalities in these workers suggests that occupational liver disease may occur more frequently than is generally recognized.

Authors+Show Affiliations

Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

3358569

Citation

Redlich, C A., et al. "Liver Disease Associated With Occupational Exposure to the Solvent Dimethylformamide." Annals of Internal Medicine, vol. 108, no. 5, 1988, pp. 680-6.
Redlich CA, Beckett WS, Sparer J, et al. Liver disease associated with occupational exposure to the solvent dimethylformamide. Ann Intern Med. 1988;108(5):680-6.
Redlich, C. A., Beckett, W. S., Sparer, J., Barwick, K. W., Riely, C. A., Miller, H., Sigal, S. L., Shalat, S. L., & Cullen, M. R. (1988). Liver disease associated with occupational exposure to the solvent dimethylformamide. Annals of Internal Medicine, 108(5), 680-6.
Redlich CA, et al. Liver Disease Associated With Occupational Exposure to the Solvent Dimethylformamide. Ann Intern Med. 1988;108(5):680-6. PubMed PMID: 3358569.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Liver disease associated with occupational exposure to the solvent dimethylformamide. AU - Redlich,C A, AU - Beckett,W S, AU - Sparer,J, AU - Barwick,K W, AU - Riely,C A, AU - Miller,H, AU - Sigal,S L, AU - Shalat,S L, AU - Cullen,M R, PY - 1988/5/1/pubmed PY - 1988/5/1/medline PY - 1988/5/1/entrez SP - 680 EP - 6 JF - Annals of internal medicine JO - Ann Intern Med VL - 108 IS - 5 N2 - STUDY OBJECTIVE: to characterize an outbreak of liver disease among workers in a fabric coating factory; and to determine the outbreak's cause and natural history and strategies for clinical recognition, treatment, and prevention. DESIGN: clinical-epidemiological investigation. SETTING: academic medical center, Occupational Medicine Clinic, and worksite. PATIENTS: fifty-eight of sixty-six workers participated in the study. All had standard liver function tests at least once. Forty-six workers completed a questionnaire; 27 had more extensive clinical evaluation for recognized liver abnormalities. RESULTS: a plant-wide outbreak of liver disease was recognized after a new employee presented with signs and symptoms of hepatitis. Evaluation of the worksite showed that dimethylformamide, a widely used industrial solvent and known hepatotoxin, was being used to coat fabric in poorly ventilated areas without appropriate skin protection. No other major hepatotoxic exposure was identified. Overall, 36 of 58 (62%) workers tested had elevations of either aspartate aminotransferase (AST) or alanine aminotransferase (ALT) levels. Enzyme abnormalities occurred almost exclusively in production workers (35 of 46 were abnormal), whereas only 1 of 12 nonproduction workers showed any elevations in enzyme levels (P less than 0.0001). Serologic tests excluded known infectious causes of hepatitis in all but 2 workers and changes characteristic of toxic liver injury were confirmed by histologic examinations of biopsy specimens from 4 workers. The ratio of AST to ALT levels was one or less in all but 1 worker. After modification of work practices and removal of workers most severely affected from exposure, improvement in liver enzyme abnormalities and symptoms in most patients were seen, although some patients showed persistent elevations of enzyme levels. CONCLUSIONS: an outbreak of toxic liver disease has been associated with exposure to dimethylformamide in the workplace. The diagnosis of toxic liver disease was established by the clinical histories, negative viral serologies, an enzyme pattern of ALT levels being greater than AST levels, epidemiologic data on coworkers, and liver biopsy specimens. The high prevalence of unsuspected liver enzyme abnormalities in these workers suggests that occupational liver disease may occur more frequently than is generally recognized. SN - 0003-4819 UR - https://www.unboundmedicine.com/medline/citation/3358569/Liver_disease_associated_with_occupational_exposure_to_the_solvent_dimethylformamide_ L2 - https://www.acpjournals.org/doi/10.7326/0003-4819-108-5-680?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -