Hydrogen Sulfide Intoxication with Dilated Cardiomyopathy

Hydrogen sulfide (H 2 S) is a colorless, heavier-than-air, inflammable, highly toxic irritant and chemical asphyxiant gas, which has a characteristic rotten-egg odor that is detectable at concentrations as low as 0.5 ppb, but this warning property may be lost in 2 to 15 min at concentrations over 100 ppm through olfactory fatigue . Hydrogen sulfide is generated naturally by decaying sulfur-containing proteins and is released from sewage sludge, liquid manure, sulfur hot springs, and natural gas. It is also a by-product of many industrial processes, including petroleum refining, sewage disposal, mining, wood pulp processing, rayon manufacturing, manure processing, sugar-beet processing, fish processing and hot-asphalt paving . Hydrogen sulfide is especially risky in confined spaces such as fishing-ship holders, manure pits, and sewers. In the United States, 52 deaths related to hydrogen sulfide were reported from 1993 to 1999 in various industries. The toxic mechanism of hydrogen sulfide comprises inactivating cytochrome oxidase in mitochondria and then preventing the cellular metabolism of oxygen. Via this mechanism, hydrogen sulfide can induce hypoxic brain damage and hypoxic cardiac damage as well as mucosal irritation and pulmonary edema. Nevertheless, few cases of cardiac damage following hydrogen sulfide exposure have been reported. We here report a case of dilated cardiomyopathy after hydrogen sulfide inhalation in a sewer worker, the first case report of dilated cardiomyopathy caused by hydrogen sulfide. Case Presentation