A Case of Dilated Cardiomyopathy Associated With Chronic Toluene Exposure.

A 56-year-old woman working in a factory for the past 34 years presented with dilated cardiomyopathy of unknown etiology. She was exposed daily to toluene at work, without adequate protective equipment. A public health department investigation reported that toluene exposure among workers at her factory was more than 3 times the established limit. Toluene inhalation is associated with cases of cardiac arrhythmias, vasospasm, and cardiomyopathy. Occupational exposure to cardiotoxic substances should be investigated in patients with idiopathic cardiomyopathy. This case report highlights an association between a case of dilated cardiomyopathy and chronic exposure to toluene.

Une femme de 56 ans, employée dans une usine pendant 34 ans, a reçu un diagnostic de cardiomyopathie dilatée de cause inconnue. Au travail, elle était exposée quotidiennement au toluène, sans équipement de protection adéquat. Une enquête effectuée par le département de santé au travail de la santé publique a révélé que les travailleurs de cette usine étaient exposés à une concentration de toluène supérieure à 3 fois la limite établie. L'inhalation de toluène a déjà été associée à des cas d'arythmies cardiaques, de vasospasmes et de cardiomyopathies. La possibilité d'une exposition professionnelle à des substances cardiotoxiques devrait être examinée chez les patients atteints de cardiomyopathie idiopathique. Cet article met ainsi en évidence un cas de cardiomyopathie dilatée associé à une exposition chronique au toluène.

A case of cutaneous necrosis due to intra-articular hyaluronic acid and treated with hyaluronidase.

A 66-year-old woman presented to the hospital with cutaneous necrosis of her right ankle and foot. Her symptoms began immediately after an intra-articular injection of hyaluronic acid for ankle osteoarthritis, which was performed 6 days before. Histopathology showed an intra-vascular hyaluronic acid embolus. The initial treatment approach was conservative, but the patient's clinical state degraded. She was thus treated with sub-cutaneous hyaluronidase, the enzyme that degrades hyaluronic acid, which yielded a moderate improvement even though it was administered 22 days after the initial hyaluronic acid injection. Although hyaluronic acid embolism and subsequent cutaneous necrosis are well-known complications of dermal fillers, there are few reported cases of embolism following intra-articular injection. To our knowledge, this is the first time hyaluronidase has been used in this setting.