Systemic sclerosis and occupational exposure to organic solvents: "Perchlorethylene", a case

Systemic sclerosis (scleroderma) is an autoimmune disease whose pathophysiology remains poorly elucidated and whose mechanism is probably multifactorial. The observation of cases of scleroderma in individuals occupationally exposed to organic solvents suggests that environmental factors probably have a role in the pathogenesis of this disease. Is the induction of scleroderma due to exposure to the immunotoxic effects of solvents? We report a case of scleroderma in a patient working in the Hying wrapping industry where he was exposed to many organic solvents. Objective. - Here, the aim is to discuss occupational systemic sclerosis as related to chronic exposure to perchlorethylene (CCL2), a solvent widely used in industry and implicated in the etiology of our patient's disease, and we propose a possible preventive strategy. Observation. - The patient, aged 23 years, had worked in that industry for six years, assigned to a bonding post where he was exposed to several organic solvents, including perchlorethylene. After five years at this post, he developed symptoms suggestive of scleroderma. Findings included a positive antinuclear antibody assay, a net decrease in the number of capillaries by capillaroscopy, restricted respiratory function, and a moderate, discrete interstitial syndrome. An environmental air quality study was carried out within the company, supplemented by a quantitative meteorological study to estimate the average level of exposure to different solvents. The levels of these solvents were within acceptable norms, except for perchlorethylene, whose concentration was found to be two times higher than the norm at the place where our patient did the bonding. Conclusion. - The occupational origin of systemic sclerosis was suggested in our patient in view of his chronic exposure to perchlorethylene, a solvent widely used in industry and which has been incriminated previously in the literature as a cause of this illness. Indeed, the induction of scleroderma by solvents is biologically plausible, and it could involve an immunological mechanism, perhaps through denaturation of certain cellular proteins by solvents. This disruptive effect of immunity would be consistent, first, with the known mechanisms of scleroderma and, second, with other possible effects of exposure to organic solvents. With that in mind, and given the widespread industrial use of solvents, we must insist on compliance with collective and individual preventive measures. These measures could limit an eventual epidemic-like increase in drug-like addiction to solvents and also the risk of developing other effects on major organs, especially as these conditions are not currently recognized medico-legally. (C) 2010 Elsevier Masson SAS. All rights reserved.