Does One-off Accidental Exposure to Organic Solvents cause the Chronic Symptoms of Poisoning?

vomiting, headache and 3 hours later, numbness in the whole body and immobility followed. These symptoms are kind of severe acute poisoning. Gastrointestinal symptoms improved within a month, but severe headache continued thereafter. In addition, a red rash appeared on the exposed forearm, back of the hands, face, lower extremities and neck. Then headache and such dermatitis persisted despite a single exposure to organic solvents and bothered her life every day. She visited the Neurosurgical department of Tokyo Rosai ABSTRACT It is well known that the symptoms of acute poisoning after exposure to organic solvents decrease with time and the acute symptoms do not last for a long time. However, it is sometimes encountered that the poisoning symptoms in the acute phase might become chronic in some cases. Here we report a case with the symptom of purpura and severe headache after acute poisoning by organic solvents. The symptom is continuing even after years, and many medical treatments were failed. The mechanism of purpura and headache even in chronic stage was based on vasculitis after contamination of vessel walls by organic solvents. In this case, inflammation created in perivascular area must be origin of such purpura and hypertrophic pachymeningitis in the temporal base that inducing severe headache.


Introduction
Organic solvents are the most frequently encountered chemicals used in daily work, but due to their high volatility and fat solubility, they are easily absorbed into the body through the respiratory tract and cause toxic symptoms. Also, a certain amount is absorbed from skin contamination. Inhalation of highly concentrated organic solvents instantaneously causes acute poisoning, and long-term exposure also causes chronic symptoms [1]. It is well known that the symptoms of acute poisoning after exposure to organic solvents decrease with time and the acute symptoms do not last for a long time. However, it is sometimes encountered that the poisoning symptoms in the acute phase might become chronic in some cases.
Here, we report a case in which headache and skin symptoms persisted after a long time after one occasional history of acute poisoning of organic solvents.
Chief Complaint: Chronic severe headache and purpuric ulcer dermatitis after acute organic solvent poisoning.

Family history: No history of craniotomy.
Present Illness: On October 9, 2014, she parked the vehicle in the underground parking where another vehicle was waxed next parking place. It was accidentally happened that she inhaled dense organic solvent volatilized from the wax. Immediately after inhaling the gaseous organic solvent, nausea and headache occurred, 1 hour later, dizziness, diarrhea, vomiting, headache and 3 hours later, numbness in the whole body and immobility followed. These symptoms are kind of severe acute poisoning.
Gastrointestinal symptoms improved within a month, but severe headache continued thereafter. In addition, a red rash appeared on the exposed forearm, back of the hands, face, lower extremities Hospital about two years later. The headache was throbbing type and it started characteristically 3 hours later when lying on the bed, she had to wake up to take a sitting position because only sitting position relieved headache. Daily life was very limited due to lack of sleep and persistent headaches.
Before coming to our department, she visited on a poisoning outpatient department, a neurology department, and several neurosurgery departments and anesthesia departments, and many drugs had already been given. However, NSAIDs, triptan, ergotamin are not effective. Also, tranquilizers and antiepileptic drugs were prescribed, but rather, nausea, weakness, and worsening of headache occurred, and she could not continue taking the drug. In our department, hyperosmotic diuretics were found to be effective for headache. A dermatologist diagnosed ulcerative dermatitis that remained in both lower limbs as chronic purpura. Other dermatitis was cured. A.
Blood This finding was considered as hypertrophic pachymeningitis ( Figure 1).

E.
Ophthalmological Findings: Normal intraocular pressure, orthonormal position, and glasses were appropriate.

Organic Solvent Poisoning
Symptoms of acute intoxication of organic solvents are recovered after the organic solvents being metabolized and excreted in the urine. Further, when it remains in the body, the organic solvent is first metabolized intracellularly by cytochrome P450 and finally it is conjugated by glucuronic acid and glutathione, becomes water-soluble and is excreted through the kidney.
Generally, it is said that the chronic symptom of the organic solvent occurs when continuously exposed to a low concentration and the case where the acute symptom has remained at the chronic phase never reported.

Causal Relationship between Severe Headache and Enhanced Hypertrophic Dura Matter
The headache in this case is exacerbated by reclining. It is speculated that this was caused by a decrease in hydrostatic pressure due to recumbency, resulting in a decrease in venous

In Conclusion
Organic solvents are easily absorbed and caused acute poisoning, however if it was single exposure, it was metabolized and evacuated quickly from each organ. But invasion of organic solvent into the vascular wall caused inflammation of the vascular wall and perivascular soft tissues. Poor microcirculation of dura matter and skin of the lower limb failed to cure the inflammation. This must be the reason of chronic vasculitis after single exposure of organic solvents. It is well known that skin vasculitis is common symptom after organic solvents contamination [4]. Such vasculitis occurred to the everywhere in the body. The patient's vasculitis remained only in dura matter and lower limb where microcirculation is not enough to evacuate inflammation substances. This case taught us single exposure of organic solvents caused vasculitis in the skin and severe headache, if patient's headache exacerbated by recumbency, Gd-enhanced MRI is necessary to prove the inflammation of dura matter.