Systemic Sclerosis and Exposure to Trichloroethylene

László Czirják, 3rd Department of Medicine, University Medical School, H-4004 Debrecen (Hungary) In a recent issue Diaz et al. [1] published a case of trichloroethylene-induced systemic sclerosis. Previously, it has been described only in a few patients [2-5]. We have previously reported that exposure to solvents can be detected among the Hungarian cases with systemic sclerosis in a surprisingly high proportion [6, 7]. A 62-year-old female patient, who started her work at the age of 40 in a telecommunication plant, was exposed to trichloroethylene by inhalation for 2 years. At the age of 43, she developed Raynaud’s phenomenon, acro-sclerosis and joint symptoms. A serious involvement of the lower esophageal tract was found from the age of 47. Thirteen years later, congestive heart failure, thrombocyto-penia and renal involvement with mild azote-mia (but without hypertension) was also detected. Two years later, the patient died suddenly due to cardiac arrest. Indirect immunofluorescence showed a speckled anti-nucelar antibody staining pattern on HEp-2 cell monolayers (without anticentromere antibody). The mitotic spindles were also decorated in the dividing cells suggesting the presence of antimicrotubule antibodies. This patient had systemic scleroderma indistinguishable from the ‘true’ systemic sclerosis. References Diaz SY. Morán M, Unamuno P, Armijo M: Silica and trichloroethylene-induced progressive systemic sclerosis. Dermatology 1992; 184: 98-102. Saihan EM, Burton JL, Heaton KW: A new syndrome with pigmentation, scleroderma, gynaecomastia. Raynaud’s phenomenon and peripheral neuropathy. Br J Dermatol 1978; 99:437440. Reinl W: Sclerodermia caused by trichloroethylene? Bull Hyg 1957;32:678-679. Yamakage A, Ishikawa H: Generalized mor-phea-like scleroderma occurring in people exposed to organic solvents. Dermatologica 1982;165:186-193. Flindt-Hansen H, Isager H: Scleroderma after occupational exposure to trichloroethylene and trichlorethane. Acta Derm Venereol (Stockh) 1987;67:263-264. Czirják L, Szegedi G: Benzene exposure and systemic slcerosis (letter). Ann Intern Med 1987;107:118. Cirják L, Bokk Á, Lörincz G, Csontos G. Szegedi G: A clinical study of 61 patients with systemic sclerosis. Acta Derm Venereol (Stockh) 1989;69:533-536.