title: Occupational trichloroethylene hypersensitivity syndrome with human herpesvirus-6 and cytomegalovirus reactivation.
abstract: Patients having a generalised rash with severe liver dysfunction associated with exposure to trichloroethylene (TCE) have been reported mainly in Asian countries. However, no case has been reported in Japan since the 1990s. Here, we describe a case of hypersensitivity syndrome (HS) caused by TCE in a 30-year-old Japanese man. The patient developed a rash, fever and liver dysfunction 21 days after he had been exposed to TCE at his workplace. Serum human herpesvirus (HHV)-6 and cytomegalovirus (CMV) DNA were detected 4 and 7 weeks, respectively, after the onset; the IgG antibody titres to HHV-6 and CMV were significantly elevated 6 and 9 weeks, respectively, after the onset. Patch testing was positive for the metabolites of TCE (i.e. trichloroethanol, trichloroacetic acid and chloral hydrate) but not for TCE itself; these results suggest that the TCE metabolites induced this disease. Human leucocyte antigen-B*1301, which has been reported to be strongly associated with TCE-induced HS, was identified in this patient. In addition, the clinical findings, laboratory data and period of virus reactivation after onset were quite similar to those of drug-induced hypersensitivity syndrome (DIHS). We also review TCE-induced HS from the viewpoint of the similarity to DIHS in this article.
authors.affiliation: Department of Dermatology, Showa University School of Medicine, Tokyo, Japan. hwatanabe@med.showa-u.ac.jp
authors.forename: Hideaki
authors.initials: H
authors.lastname: Watanabe
authors.forename: Mikiko
authors.initials: M
authors.lastname: Tohyama
authors.forename: Michihiro
authors.initials: M
authors.lastname: Kamijima
authors.forename: Tamie
authors.initials: T
authors.lastname: Nakajima
authors.forename: Takemi
authors.initials: T
authors.lastname: Yoshida
authors.forename: Koji
authors.initials: K
authors.lastname: Hashimoto
authors.forename: Masafumi
authors.initials: M
authors.lastname: Iijima
mesh_terms: D000328:Adult; D000914:Antibodies, Viral / Q000097:blood; D003586:Cytomegalovirus Infections / Q000139:chemically induced* / Q000473:pathology; D004279:DNA, Viral / Q000097:blood; D009783:Dermatitis, Occupational / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D015654:Herpesvirus 6, Human / Q000187:drug effects*; D006801:Humans; D006967:Hypersensitivity / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D007136:Immunoglobulins / Q000097:blood; D008297:Male; D011239:Prednisolone / Q000627:therapeutic use; D019349:Roseolovirus Infections / Q000139:chemically induced* / Q000473:pathology; D012997:Solvents / Q000633:toxicity*; D014241:Trichloroethylene / Q000633:toxicity*; D014775:Virus Activation / Q000187:drug effects
chemical_list: D000914:Antibodies, Viral; D004279:DNA, Viral; D007136:Immunoglobulins; D012997:Solvents; D014241:Trichloroethylene; D011239:Prednisolone