직업적 노출에 의한 스티븐스-존슨 증후군에서 트리클로로에틸렌의 노출수준 - 3예의 사례와 문헌고찰을 중심으로 (Exposure Level of Trichloroethylene in Stevens-Johnson Syndrome Due to Occupational Exposure - 3 Case Reports and a Review of Other Cases)

서지정보

· 발행기관 : 대한직업환경의학회
· 수록지 정보 : Annals of Occupational and Environmental Medicine / 20권 / 2호 / 132 ~ 146페이지
· 저자명 : 이선웅, 김은아, 김대성, 고동희, 강성규, 김병규, 김민기

초록

Back ground: Trichloroethylene (TCE) has been reported to be related to severe generalized exfoliative
dermatitis frequently accompanied by toxic hepatitis. The measurements of environmental exposure
were limited in the previous case reports and the reported exposure values were also diverse. We
reviewed three cases of Stevens-Johnson syndrome associated with TCE. The work environment was
measured by the Korea Occupational Safety and Health Agency (KOSHA) after the cases occurred. From
the study results, we intended to clarify the relationship between TCE exposure level and Stevens-
Johnson syndrome.
Case report: Case 1. A 24-year-old Filipino female worker developed a skin rash 35 days after starting
to use TCE for degreasing. The skin rash developed into a bullous eruption and the liver function findings
were abnormal. She was diagnosed with Stevens-Johnson syndrome and toxic hepatitis. She died of
hepatic failure 39 days after the onset of the first symptom. She had no previous history of taking medicine
or viral infection. The work environment measured 22.0 to 32.3 ppm (personal exposure level) with
TWA. Case 2. A 47-year-old Korean male worker developed a skin rash, 20 days after starting to use
TCE for degreasing. The skin rash developed into a bullous eruption and the liver function findings were
abnormal. He was diagnosed with Stevens-Johnson syndrome, toxic hepatitis and sepsis. He died of
hepatic failure and sepsis 42 days after the onset of the first symptom. He had no previous history of taking
medicine or viral infection. The work environment measured 30.1 ppm (personal exposure level) and
116.5~229.7 ppm (area exposure level close to the degreasing machine) with TWA. Case 3. A 22-yearold
Vietnamese female worker developed a skin rash 30 days after starting to use TCE for degreasing.
The skin rash developed into a bullous eruption and the liver function findings were abnormal. She was
diagnosed with Stevens-Johnson syndrome and toxic hepatitis. Her symptoms improved and she was discharged
37 days after the onset of the first symptom. She had no previous history of taking medicine or
viral infection. The work environment measured 107.2 ppm (personal exposure level) with TWA.
Discussion: These three case reports and the previously reported cases indicated that the majority of people susceptible to TCE develops Stevens-Johnson syndrome after high-level TCE exposure (above the
TWA occupational exposure limit of 50 ppm). Therefore, work environmental survey and improvements
to the TCE degreasing process are essential to prevent high exposure. Furthermore, considering the consistency
of the latency period in symptoms and the possibility of sensitization in low-level exposure, we
recommend that the first specific health examination also should be conducted 1 month after workers
have commenced working.

영어초록

Back ground: Trichloroethylene (TCE) has been reported to be related to severe generalized exfoliative
dermatitis frequently accompanied by toxic hepatitis. The measurements of environmental exposure
were limited in the previous case reports and the reported exposure values were also diverse. We
reviewed three cases of Stevens-Johnson syndrome associated with TCE. The work environment was
measured by the Korea Occupational Safety and Health Agency (KOSHA) after the cases occurred. From
the study results, we intended to clarify the relationship between TCE exposure level and Stevens-
Johnson syndrome.
Case report: Case 1. A 24-year-old Filipino female worker developed a skin rash 35 days after starting
to use TCE for degreasing. The skin rash developed into a bullous eruption and the liver function findings
were abnormal. She was diagnosed with Stevens-Johnson syndrome and toxic hepatitis. She died of
hepatic failure 39 days after the onset of the first symptom. She had no previous history of taking medicine
or viral infection. The work environment measured 22.0 to 32.3 ppm (personal exposure level) with
TWA. Case 2. A 47-year-old Korean male worker developed a skin rash, 20 days after starting to use
TCE for degreasing. The skin rash developed into a bullous eruption and the liver function findings were
abnormal. He was diagnosed with Stevens-Johnson syndrome, toxic hepatitis and sepsis. He died of
hepatic failure and sepsis 42 days after the onset of the first symptom. He had no previous history of taking
medicine or viral infection. The work environment measured 30.1 ppm (personal exposure level) and
116.5~229.7 ppm (area exposure level close to the degreasing machine) with TWA. Case 3. A 22-yearold
Vietnamese female worker developed a skin rash 30 days after starting to use TCE for degreasing.
The skin rash developed into a bullous eruption and the liver function findings were abnormal. She was
diagnosed with Stevens-Johnson syndrome and toxic hepatitis. Her symptoms improved and she was discharged
37 days after the onset of the first symptom. She had no previous history of taking medicine or
viral infection. The work environment measured 107.2 ppm (personal exposure level) with TWA.
Discussion: These three case reports and the previously reported cases indicated that the majority of people susceptible to TCE develops Stevens-Johnson syndrome after high-level TCE exposure (above the
TWA occupational exposure limit of 50 ppm). Therefore, work environmental survey and improvements
to the TCE degreasing process are essential to prevent high exposure. Furthermore, considering the consistency
of the latency period in symptoms and the possibility of sensitization in low-level exposure, we
recommend that the first specific health examination also should be conducted 1 month after workers
have commenced working.

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