A Rare Case of Occupational Aniline Poisoning: Management in a Limited-Facility Setting

Abstract

Introduction Cyanosis along with altered mental should bring all the possible ethiologies into her mind in a minimum of time, based on the trauma, medical, environmental, and occupational history of the patient. Poisoning with methemoglobinemia inducing agents is one of the most important differentials especially when a history of occupational exposure to these agents is present. Case Report The patient, a 41-year-old healthy woman and engineer, experienced symptoms after exposure to aniline leading to dizziness and weakness, prompting a visit to the emergency department with cyanosis and low oxygen saturation. Initial vital signs showed decreased oxygen levels and elevated respiratory rate with normal ABG values despite ongoing cyanosis. Patient required intubation, mechanical ventilation, and was diagnosed with ARDS based on chest X-ray findings. Management included IV diuretics, 100% oxygen, and antioxidant treatment in the ICU. Despite treatment, oxygen saturation remained at 88% on the first day. Conclusion This case is a reminder of the importance of taking occupational history and management of aniline toxicity in a setting where methylene blue, the drug of choice for aniline toxicity, is not available in the drug stock. Keywords aniline, aniline poisoning, occupational medicine, emergency medicine, toxicology Ethical Statement Ethical approval is not required since our patient's treatment was based on approved options, and it was not found to be controversial, according to the Ethics Committee of our institution (Iran National Committee for Ethics in Biomedical Research). Supporting Institution Not applicable. Thanks Not applicable. References * 1. Uter W, Stropp G, Schnuch A, Lessmann H. Aniline—A ‘Historical’Contact Allergen? Current Data from the IVDK and Review of the Literature. The Annals of Occupational Hygiene. 2007;51(2):219-26. * 2. Wang Y, Gao H, Na X-L, Dong S-Y, Dong H-W, Yu J, et al. Aniline induces oxidative stress and apoptosis of primary cultured hepatocytes. International Journal of Environmental Research and Public Health. 2016;13(12):1188. * 3. Acute Exposure Guideline Levels for Selected Airborne Chemicals: Volume 1. 2000 Available from: https://www.ncbi. nlm.nih.gov/books/NBK222410/. * 4. Di Girolamo F, Campanella L, Samperi R, Bachi A. Mass spectrometric identification of hemoglobin modifications induced by nitrosobenzene. Ecotoxicology and Environmental Safety. 2009;72(5):1601-8. * 5. Harrison J, Jollow D. Contribution of aniline metabolites to aniline-induced methemoglobinemia. Molecular pharmacology. 1987;32(3):423-31. * 6. Fan X, Wang J, Soman KV, Ansari G, Khan MF. Aniline-induced nitrosative stress in rat spleen: proteomic identification of nitrated proteins. Toxicology and applied pharmacology. 2011;255(1):103-12. * 7. Genkin S, Raschewskaja A. The Diagnosis of Chronic Anilin Poisoning. Zentralblatt fur Gewerbehygiene und Unfallverhutung. 1933;20:29-36. * 8. LUBASH GD, PHILLIPS RE, SHIELDS JD, III, BONSNES RW. Acute Aniline Poisoning Treated By Hemodialysis: Report of a Case. Archives of Internal Medicine. 1964;114(4):530-2. * 9. Cannata G, Abate L, Scarabello C, Rubini M, Giacometti A, Principi N, et al. The Dose Makes the Poison: A Case Report of Acquired Methemoglobinemia. International Journal of Environmental Research and Public Health. 2020;17(6):1845. * 10. Messmer AS, Nickel CH, Bareiss D. <i>P</i>-Chloroaniline Poisoning Causing Methemoglobinemia: A Case Report and Review of the Literature. Case Reports in Emergency Medicine. 2015;2015:208732. * 11. Wright RO, Lewander WJ, Woolf AD. Methemoglobinemia: etiology, pharmacology, and clinical management. Ann Emerg Med. 1999;34(5):646-56. * 12. Hall AH, Kulig KW, Rumack BH. Drug- and chemical-induced methaemoglobinaemia. Clinical features and management. Med Toxicol. 1986;1(4):253-60. * 13. Bradberry SM, Aw T-C, Williams NR, Vale JA. OCCUPATIONAL METHAEMOGLOBINAEMIA. Occupational and Environmental Medicine. 2001;58(9):611-. * 14. Harvey JW, Keitt AS. Studies of the efficacy and potential hazards of methylene blue therapy in aniline-induced methaemoglobinaemia. Br J Haematol. 1983;54(1):29-41. * 15. Kumar YR, Kumar P, Prasad M, Radhika A, Edara AC. Occupational inhalation of aniline fumes induced methemoglobinemea and hemolytic anemia precipitated days later. Indian Journal of Occupational and Environmental Medicine. 2014;18(2):95-6. * 16. Mier M.D RJ. Treatment of Aniline Poisoning with Exchange Transfusion. Journal of Toxicology: Clinical Toxicology. 1988;26(5-6):357-64. * 17. Lee CH, Kim SH, Kwon DH, Jang KH, Chung YH, Moon JD. Two Cases of Methemoglobinemia Induced by the Exposure to Nitrobenzene and Aniline. Annals of Occupational and Environmental Medicine. 2013;25(1):31.