Sakamoto M, Miyajima H, Mizoguchi K, Nishimura Y, Kaneko E
First Department of Internal Medicine, Hamamatsu University School of Medicine.
Rinsho Shinkeigaku. 1992 May;32(5):516-20.
We reported a 27-year-old man, who had inhaled toluene vapor for 11 years and developed both polyneuropathy and myopathy. He gradually developed progressive muscular weakness in the limbs 2 months after the last inhalation and became nonambulant. Neurological examination revealed distal dominant muscular weakness and hypoactive deep tendon reflexes, especially in the legs. The cranial nerves were intact and neither sensory disturbances nor cerebellar signs were observed. Laboratory studies demonstrated mildly elevated serum CK value, but serum electrolytes and urinalysis were normal. Electromyogram showed a neurogenic pattern in the limbs and also a myogenic in the gastrocnemius muscle. Motor nerve conduction velocities were delayed in the limbs. The sural nerve biopsy specimens showed demyelination, myelin avoids, and axonal swelling compatible with toxic neuropathy. The muscle biopsy of the gastrocnemius revealed necrotic muscle fibers, vacuolated muscle fibers, phagocytosis, a disordered intermyofibrillary network, and small group atrophy on light microscopy. On electron microscopy, two outstanding findings were observed; the first, dilatation and proliferation of the membrane system, and the second, appearance of irregular membrano lamellar structures and vacuoles associated with abnormal membrane system. These histological findings suggest that toluene may affect directly the membrane system of muscle fibers and consequently induce rhabdomyolysis.
我们报告了一名27岁男性，他吸入甲苯蒸气11年，并发了多发性神经病和肌病。在最后一次吸入后2个月，他逐渐出现四肢进行性肌无力，最终无法行走。神经系统检查发现以远端为主的肌无力和腱反射减弱，尤其是在腿部。颅神经完好，未观察到感觉障碍或小脑体征。实验室检查显示血清肌酸激酶（CK）值轻度升高，但血清电解质和尿液分析正常。肌电图显示四肢呈神经源性模式，腓肠肌呈肌源性模式。四肢运动神经传导速度延迟。腓肠神经活检标本显示脱髓鞘、髓鞘脱失和轴突肿胀，符合中毒性神经病。腓肠肌肌肉活检在光学显微镜下显示坏死的肌纤维、空泡化的肌纤维、吞噬现象、肌原纤维间网络紊乱和小群性萎缩。在电子显微镜下，观察到两个突出的发现：第一，膜系统的扩张和增殖；第二，出现与异常膜系统相关的不规则膜状层结构和空泡。这些组织学发现表明，甲苯可能直接影响肌纤维的膜系统，从而诱发横纹肌溶解。
