• Journal of Korean Society of Occupational and Environmental Hygiene
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• v.23 no.3
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• pp.169-176
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• 2013

Objectives: The aim of this study is to critically review the health effects of not only direct exposure to biocide, but also indirect exposure to by-product hazardous agents generated through the use of biocide in metalworking operations. Methods: An extensive literature review was conducted of studies reporting on respiratory disease cases, particularly hypersensitivity pneumonitis (HP), in environments using water-soluble metalworking fluids (MWFs). Keyword search terms included 'metalworking fluids', 'machining fluids', 'metalworking operation' 'machining operation' and 'biocide', which were also used in combination. Additional articles were identified in references cited in the articles reviewed. Results: Several of the field, epidemiological and experimental studies reviewed assumed that the symptoms and signs typical of HP developed in machinists who handled water-soluble MWF could be caused by inhalation exposure to nontuberculous mycobacteria (NTM). Most NTM are known to be not only resistant to both biocide and disinfectant, but also to have acid-fast cell walls that are highly antigenic. The presence or persistence of the Mycobacterium species, referred to as NTM, in metalworking fluid-using operations may be caused by NTM contamination in either the natural water or tap water that is used to dilute the base oil and additives for water-soluble MWFs. This hypothesis that NTM contamination in water-soluble MWFs is a causative agent of HP has high biologic plausibility, such as antigenic property, hydrophobicity and small diameter (< 5 um). Conclusions: Aerosolized mycobacteria colonized from MWF are likely to be causing the HP. Inhalation exposure to mycobacteria should be considered as a possible cause for the development of HP.

• Pediatric Infection and Vaccine
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• v.23 no.1
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• pp.67-71
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• 2016

Erythema nodosum (EN) is a painful skin disease characterized by erythematous tender nodules located predominantly over the extensor aspects of the legs. Various etiological factors, including infection, drug administration, and systemic illness have been implicated as causes of EN. Mycoplasma pneumoniae is one of rare infectious agents to cause EN in children. We report a case of a 7-year-old boy with context of respiratory illness and skin lesions with arthralgia. From stepwise approaches, IgM antibody against M. pneumoniae was positive with titers of 12.18, consistent with respiratory infection of M. pneumoniae and histopathology showed findings of septal and lobular inflammation without vasculitis consistent with EN. In addition, we reviewed the pathogenesis of this disease based on our case and the previous reports.

• Tuberculosis and Respiratory Diseases
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• v.50 no.3
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• pp.367-372
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• 2001

Bacillus Calmette-Guerin(BCG) has been widely used for the prophylaxis of superficial bladder tumor recurrence and for the treatment of bladder carcinoma in situ. More than 95% of patients who receive BCG instillation tolerate the treatment well and side reactions have been reported in less than 5% of patients. Most side effects are minor and self-limiting. However, a rare occurrence of severe systemic reactions have been reported. Among the severe systemic reactions, hypersensitivity pneumonitis should be considered in patients with pneumonic complications after BCG instillation in cases where the culture for mycobacteria is negative in the sputwn, brochoalveolar lavage and blood specimen. In addition, a fiberoptic bronchoscopy with transbronchial lung biopsy demonstrates a fibrosis of the alveolar septums, where there is and an increased lymphocyte count with out tuberculous inflammatory changes, the and CD4 : CD8 ratio is increased and no symptomatic response to antituberculosis chemotherapy is observed. Here we report a 68 years old man with interstitial pneumonitis following intravesical BCG instillation.

• Tuberculosis and Respiratory Diseases
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• v.50 no.4
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• pp.504-509
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• 2001

There are numerous agents with potential toxic effects on the lung. In particular, cytotoxic drugs constitute the largest and most important group of agents associated with lung toxicity. Bleomycin is commonly used, either alone or in combination with other chemotherapeutic agents, in the treatment of squamous cell carcinoma(head and neck, esophagus, and genitourinary tract), lymphoma, and germ cell tumor. One of the therapeutic advantages of bleomycin is its minimal bone marrow toxicity. However, pulmonary toxicity is one of the most serious adverse side effects. Classically, pulmonary toxicity manifests as a diffuse interstitial process or less commonly as a hypersensitivity reaction. This pulmonary toxicity is generally considered to be dose related and can progress to a fatal fibrosis. It is also possible that bronchiolitis obliterans organizing pneumonia(BOOP) is another manifestation of bleomycin induced toxicity. Bleomycin induced BOOP is less common and has a favorable response to steroid therapy. Here we present a case that demonstrates a BOOP, secondary to a relatively small cumulative dose of bleomycin($225mg/m^2$), may be reversible.

• Tuberculosis and Respiratory Diseases
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• v.45 no.1
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• pp.191-196
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• 1998

Follicular bronchitis/bronchiolitis is pathologically characterized by peribronchiolar lymphoid follicles, which is one of reactive pulmonary lymphoid disorders. It is associated with 1) the result of infections such as mycoplasma, chlamydia etc., 2) immunodeficiency syndromes, 3) connective tissue diseases such as rheumatoid arthritis and Sjogren's syndrome and 4) local or systemic hypersensitivity reaction. And it can be also developed without obvious causes and associated diseases(idiopathic). Radiologically it represents as bilateral interstitial patterns of pulmonary infiltrates. In this case, a 49 year-old woman was presented with intermittent cough and sputum. On chest X-ray and CT, $5\times4$ cm sized mass in right upper lobe and paratracheal lymphadenopathies were detected, by which lung malignancy was suspected. Bronchoscopy, trans bronchial lung biopsy and transthoracic needle aspiration showed non-specific findings only. After right upper lobectomy, we could confirm a case of follicular bronchiolitis which presented as an unusual mass-like radiologic finding.

• Tuberculosis and Respiratory Diseases
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• v.70 no.1
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• pp.43-50
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• 2011

Background: Open lung biopsy is used for diagnosis of diffuse infiltrative lung diseases (DILD), but it is invasive and relatively expensive procedure. Fluoroscopy-guided cutting needle lung biopsy (FCNLB) has merits of avoidance of admission and rapid diagnosis. But diagnostic accuracy and safety were not well known in the diagnosis of DILD. Methods: We included 52 patients (37 men, 15 women) having DILD on HRCT with dyspnea, except the patients who could be confidently diagnosed with clinical and HRCT findings. FCNLB was performed using 16G Ace cut needle (length 1.5 cm, diameter 2 mm) at the area of most active lesion on HRCT. Final diagnoses were made by the consensus. Results: The mean interval between the HRCT and FCNLB was 4.5 days. Most cases were performed one biopsy during 5~10 minutes. Specific diagnosis was obtained in 43 of 52 biopsies (83%). The most common diagnosis was nonspecific interstitial pneumonia (11 cases) and followed by cryptogenic organizing pneumonia (7 cases), diffuse alveolar hemorrhage and usual interstitial pneumonia (5 cases in each), hypersensitivity pneumonitis (3 cases), tuberculosis and drug induced interstitial pneumonitis (2 cases in each), the others are in one respectively. Mild complication was developed in 9 patients (8 pneumothorax, 1 hemoptysis). Most of complications were regressed without treatment except one case with chest tube insertion for pneumothorax. Conclusion: Fluoroscopy-guided 16 G cutting needle lung biopsy was an useful method for the diagnosis of DILD.

• Allergy, Asthma & Respiratory Disease
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• v.12 no.1
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• pp.35-39
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• 2024

Allergy to crickets is uncommon and usually reported from workers who breed, manufacture, or consume them as food for either pets or for themselves. Although there are several reports of hypersensitivity reactions to crickets in other countries, there has been few published reports in this country. Here we report a case of a 20-year-old Korean male who had been exposed for a year in his workplace and developed occupational asthma and rhinitis sensitized to Gryllus bimaculatus (GB). The patient developed respiratory and cutaneous symptoms whenever he was exposed to or came into contact with GBs or dust from the cage storing the GBs. To identify the causative allergen in his workplace, soluble GB extracts were prepared with phosphate-buffered saline and was used for skin prick test (SPT) and immunologic studies. The patient showed positive results to GB extracts as well as to house dust mite (HDM) on SPT, while negative responses were noted in 3 unexposed controls. Higher level of serum GB-specific IgE by enzyme-linked immunosorbent assay (ELISA) was noted in the patient compared to those of 18 unexposed controls. The IgE-ELISA Inhibition test showed significant inhibitions with serial additions of GB extracts without any inhibitions with HDM extracts. Sodium dodecyl sulphate-polyacrylamide gel electrophoresis and IgE-immunoblot analysis demonstrated several IgE binding components (range, 60-75 kDa). The patient was asked to avoid cricket exposure, and symptoms improved with the application of inhaled corticosteroids. Herein, we report a case of occupational asthma and rhinitis due to GB in an exposed worker.

• Safety and Health at Work
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• v.3 no.1
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• pp.1-10
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• 2012

The aim of this review was to assess current knowledge related to the occupational exposure limit (OEL) for fluid aerosols including either mineral or chemical oil that are generated in metalworking operations, and to discuss whether their OEL can be appropriately used to prevent several health risks that may vary among metalworking fluid (MWF) types. The OEL (time-weighted average; 5 mg/$m^3$, short-term exposure limit ; 15 mg/$m^3$) has been applied to MWF aerosols without consideration of different fluid aerosol-size fractions. The OEL, is also based on the assumption that there are no significant differences in risk among fluid types, which may be contentious. Particularly, the health risks from exposure to water-soluble fluids may not have been sufficiently considered. Although adoption of The National Institute for Occupational Safety and Health's recommended exposure limit for MWF aerosol (0.5 mg/$m^3$ ) would be an effective step towards minimizing and evaluating the upper respiratory irritation that may be caused by neat or diluted MWF, this would fail to address the hazards (e.g., asthma and hypersensitivity pneumonitis) caused by microbial contaminants generated only by the use of water-soluble fluids. The absence of an OEL for the water-soluble fluids used in approximately 80-90 % of all applicants may result in limitations of the protection from health risks caused by exposure to those fluids.

• Journal of The Korean Society of Clinical Toxicology
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• v.6 no.2
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• pp.99-103
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• 2008

Purpose: Chlorine gas is a common irritant that usually causes mild respiratory symptoms. One severe symptom, RADS (Reactive Airway Dysfunction Syndrome), is not well known to physicians. We analyzed the clinical features of chlorine gas exposure. Methods: We prospectively collected 25 cases of chlorine gas exposure near our emergency center on January 10th, 2007, and analyzed demographic data, event-to-ER interval, symptoms, and laboratory results based on medical records. Results: Only 2 patients out of 25 were admitted because of severe symptoms, the rest were discharged without complications. Sixty percent of them visited the ER within 12 h of exposure. The most common symptoms were chest discomfort (60%), headache (40%), nausea (40%), throat irritation (26%), and cough (32%). Two out of eight dyspnea cases showed abnormal pulmonary function, but only one case was diagnosed as RADS. Conclusion: Most symptoms after chlorine gas exposure can be treated conservatively. However, patients with chlorine exposure should be followed up long term for delayed complications.

• Allergy, Asthma & Respiratory Disease
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• v.12 no.4
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• pp.204-208
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• 2024

Autoimmune diseases have been observed in patients with Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN); however, acquired hemophilia, which can develop owing to autoimmune diseases, has not yet been reported SJS/TEN patients. A 74-yearold male patient, who had been treated for SJS after allopurinol exposure, was referred to our clinic due to hypotension and mucosal erosions. He was suspected to have septic shock due to widespread mucosal involvement caused by SJS, which improved after 1 week of intensive conservative treatment that included antibiotics and systemic corticosteroids. However, a rapid increase in prothrombin time (> 60 seconds) and activated partial thromboplastin time (> 120 seconds) was confirmed, and the mixture of the 2 materials did not improve decreased factor VIII activity (18.7%). The patient was diagnosed with acquired hemophilia, which was probably associated with SJS. In this case, acquired hemophilia, a fatal and rare autoimmune disease, occurred concurrently with SJS.