Occupational exposure

A 40 year old man presented to hospital with abdominal pain, nausea and headache two weeks after starting work as a fabric coating machine operator. He stated that other workers suffered similar effects. Liver function tests showed an elevated AST. Alkaline phosphatase and bilirubin concentrations at this time were normal. Tests for hepatitis A IgM antibody and hepatitis B surface antigen were negative. An abdominal ultrasound was normal. He was thought to have toxic hepatitis and was removed from his work; his symptoms resolved. The ALT was elevated at three times normal 3.5 months later. A liver biopsy showed changes consistent with resolving toxic injury, including evidence of diffuse regeneration, binucleated hepatocytes and variation in nuclear size. There was also spotty unicellular necrosis, enlarged Kupffer cells within the sinusoids and diffuse steatosis. There was no evidence of chronic disease. Transaminase concentrations returned to normal 6 months after removal from exposure. Workplace evaluation found that large quantities of DMF and several other solvents in lesser quantities, were used in poorly ventilated areas without appropriate skin protection. A survey of the other workers found that 33 (62%) have elevated AST or ALT concentrations. Of these 19 (33%) had elevations greater than twice normal. These 19 workers were moved from direct exposure to DMF and transaminase concentrations returned to normal within 1-5 months (Redlich et al., 1988).

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