Sanada Ayaka, Nihei Shun-Ichi, Ishikawa Shigeto, Yamashita Misako, Monoe Chikako, Ootsubo Hiroki, Kamochi Masayuki, Mayumi Toshihiko
Department of Emergency Medicine, School of Medicine, University of Occupational and Environmental, Health, Japan. Yahatanishi-ku, Kitakyushu 807-8555, Japan.
Intensive Care Unit, University Hospital, University of Occupational and Environmental Health, Japan. Yahatanishi-ku, Kitakyushu 807-8556, Japan.
J UOEH. 2022;44(2):185-190. doi: 10.7888/juoeh.44.185.
Toluidine is a known cause of bladder cancer, but it is less widely recognized as a cause of methemoglobinemia because methemoglobinemia is rare. We herein report a case of methemoglobinemia caused by toluidine in a 50-year-old man. A solution of toluidine overflowed from its container during transportation and adhered to the man's clothes, but he drove to his workplace 100 km away without changing his clothes or undergoing decontamination. Before arriving at his workplace, he developed dyspnea and called emergency services, and he was then transported to a local hospital. He had significant cyanosis upon arrival, and arterial blood gas analysis revealed a high methemoglobin level of 44%. He was diagnosed with toluidine-induced methemoglobinemia and was transported to our hospital, where he was admitted to the intensive care unit. Treatment for methemoglobinemia was started immediately after hospitalization, and the patient's symptoms and methemoglobin level improved. Methemoglobinemia should be considered in workers who handle toluidine and develop cyanosis and dyspnea.
甲苯胺是膀胱癌的已知病因，但由于高铁血红蛋白血症较为罕见，它作为高铁血红蛋白血症病因的情况则较少被广泛认识。我们在此报告一例50岁男性因甲苯胺导致高铁血红蛋白血症的病例。在运输过程中，甲苯胺溶液从容器中溢出并附着在该男子的衣服上，但他未更换衣服或进行去污处理就驾车前往100公里外的工作场所。在到达工作场所之前，他出现呼吸困难并呼叫了急救服务，随后被送往当地医院。他到达时出现明显的发绀，动脉血气分析显示高铁血红蛋白水平高达44%。他被诊断为甲苯胺诱导的高铁血红蛋白血症，并被转送至我院，在我院被收入重症监护病房。住院后立即开始对高铁血红蛋白血症进行治疗，患者的症状和高铁血红蛋白水平均有所改善。对于接触甲苯胺并出现发绀和呼吸困难的工人，应考虑高铁血红蛋白血症的可能。
