Immunological manifestations in paraphenylenediamine poisoning

Objective: Our aim is to establish the immunologic profile of PPD-intoxicated persons based on monitoring of the inflammatory reaction. Methods and patients: A prospective study of 21 patients hospitalized in a medical ICU with PPD intoxication during 2010. A follow-up of demographic, clinical, paraclinical and evolutive parameters as well as an inflammatory check-up (white blood cell, C-reactive protein, C3 and C4 fractions of complement and lymphocyte subpopulations CD3, CD4, CD8 and CD19) was realized for all patients. The kinetic of these parameters was compared with clinical and paraclinical evolution. Results: The monitoring of the inflammatory reaction in our patients shows an evolution at three times for this reaction, with the first time of inflammatory stress during the first 3 days after the intoxication characterized by a relative immunodepression, the second time from the third day when the rhabdomyolysis exerts its pro-inflammatory power and the third time (from the sixth day) corresponds to the immunomodulative action of PPD and to its oxidative metabolism. It’s a systemic and specific inflammatory reaction to a cytotoxic cell support, which would explain the secondary worsening of the clinical and paraclinical parameters of our patients (hemodynamic shock, multivisceral failure, etc.). Conclusion: It seems that the immunological aspect may present the answer to several questions that rhabdomyolysis alone could not answer during PPD-poisoning. This study tried to establish a first immunologic profile of PPD-intoxicated persons, and to correlate it with their evolution.