목적: 주성분이 염화메틸렌(Methylene chloride)인 재생 세척제를 취급하는 근로자에서 발생한 독성간염 1례를 보고한다. 방법: 열감, 오한, 근육통 등의 증상을 주소로 내원한 염화메틸렌을 사용하여 세척한 반도체 부품을 검사, 포장하는 작업에 종사한 27세 여성 근로자를 대상으로 혈액검사, 간 초음파 검사, 복부 전산화단층촬영 등의 임상검사와 작업장 조사를 실시하였다. 결과: 환자는 입원 후 시행한 검사실 검사와 방사선학적 검사상 급성 간염의 소견을 보였다. A, B및 C형 간염 표지자 검사 및 자가면역성질환 검사 등은 모두 음성이었다. 문진 상 알코올성 간염을 일으킬 정도의 음주력이나 관련 약물의 복용 및 약물알러지의 병력이 없었다. 입원 후 보존적인 치료로 증상 및 검사실 소견이 급속히 호전되었다. 퇴원 후작업장에 복귀하여 염화메틸렌에 재 노출되었을 때 이전의 증상이 재발되어 작업 2일 후 재입원 하였다. 재 입원 후 시행한 검사실 검사에서도 급성 간염의 소견을 보였고, 전회와 동일한 치료로 증상이 호전되고 간효소 수치가 정상화되어 입원 12일째 퇴원하였다. 결론: 환자의 임상증상, 검사결과, 노출력 및 과거 력상 본 증례에서의 간손상이 염화메틸렌과 관련이 있을 것으로 추정된다.
Objectives: To report a case of toxic hepatitis in a worker exposed to a cleansing agent mainly composed of methylene chloride. Methods: A 27-year-old female worker who had worked in an inspection and packing position of semiconductor parts in a factory using methylene chloride as a metal cleansing solvent was hospitalized due to fever, chill and generalized aches. We evaluated her with blood tests, abdominal ultrasonographic scan and abdominal CT scan and also took her occupational history. Results: The patient showed acute hepatitis in blood and radiologic tests after admission. The serologic tests for viral hepatitis A, B, C and autoimmune hepatitis were negative. She had no history of significant alcohol use, recent medication or drug allergy. After admission, her symptoms were improved and liver enzyme levels(AST and ALT) were markedly reduced. She returned to her workplace after discharge. Thereafter, however, her previous symptoms were recurred and she was hospitalized again 2 days after returning to her workplace. After this second admission, she showed acute hepatitis in blood tests and her symptoms were improved and liver enzyme levels were markedly reduced with the same pattern as those of the first admission. On the 11th day of the second admission, liver enzyme levels were normalized and she was discharged from hospital. Conclusions: We presume that this patient`s liver injury was related to the methylene chloride presence at her workplace due to her clinical symptoms, blood tests, radiologic tests and occupational history.