Trichloroethylene-Induced Hypersensitivity Syndrome: A Disease Caused by Metabolites

Patients suffering from a hypersensitivity syndrome (HS) caused by Trichloroethylene (TCE) have been reported mainly in Asian countries. However, due to its reported extremely low incidence rate, it’s rarely to encounter two patients from the same factory. We hospitalized two male cases who suffered from TCE-induced HS. Both patients developed exfoliative dermatitis, fever and liver dysfunction after unequivocal TCE exposure. Depending on the extent of their rash and liver injury, both patients were administered large doses of methylprednisolone intravenously with a tapering dose every 2 to 5 days. For the follow-up study, Ophthalmic examinations (Tear Breakup Time, Schirmer Test) were abnormal. TCE-induced HS patients can be successfully treated with appropriate glucocorticoid, although xerophthalmia may continue as sequelae. Patch testing was positive for Chloral hydrate, Trichloroethanol and Trichloroacetic acid but not TCE. The positive results suggest that Chloral hydrate, Trichloroethanol and Trichloroacetic acid (metabolites of TCE) are responsible for the hypersensitivity.