Fatal Case of Encephalitis After Phenolphthalein Ingestion

Abstract

TALC PNEUMOCONIOSIS BRISHr 1461 tions revealed no abnormality in the levels of his total and differential white count. His serum alkaline phosphatase, serum proteins, albumin/globulin ratio, serum calcium, P.C.V., and E.S.R. were within normal limits. His maximum breathing capacity was 62.5 litres a minute and his vital capacity 1,700 c.cm. A chest x-ray film showed small areas of nodulation scattered fairly uniformly throughout all zones of both lung fields (see Fig.). These nodularRadiograph showing small areas of nodulation in both lung fields.shadows were closely packed, and under the hand lens appeared to be of fairly homogeneous density. There was also evidence of a lattice-or matrix-work background on which the nodular deposits were superimposed. In the right upper lobe, apex, and first space there was evidence of a diffuse opacity suspiciously like pulmonary tuberculosis. Radiologically the findings were thought to be those of talc pneumoconiosis probably complicated by apical pulmonary tuberculosis.Occupational History.-This patient had been employed for 43 years (starting at 14 years of age) in the textile industry. His occupation was that of picker maker. These employees are concerned in making thongs, originally of buffaio hide, but in recent years from any type of leather skin. The picker is employed to drive the shuttle which threads the weft in the weaving loom from side to side.The hide is first steeped in a vat of water for three hours and is then hung up for five minutes to allow the surplus fluid to drain off. It is next placed on old-sacking on the floor and dusted liberally with talc (French chalk, hydrated magnesium silicate). The talc is now spread uniformly on the hide by means of a whitewash brush. The hide is then reversed and the process repeated. Later the hide is lifted by two picker makers on to a table, and throughout these operations the atmosphere is cloudy with fine talc dust. Each week about 40 hides, each 12 by 6 ft. (3.6 by 1.8 metres) in size, are treated in this fash on by each picker maker. It was after working 39 years in this process that the patient began to observe the symptoms indicated above. DiscussionPetrographically, talc consists of straight fibres, curved fibres, and shreds. These fibres measure up to 10 M in length, though many are only 4 to 5 it. Radiological evidence of talc plaques varying from single linear strands in the region of the diaphragm to massive deposits, bizarre in shape, extending over a large part of the lung fields, has been recorded by Siegal et al. (1943). There is no certain association between talc pneumoconiosis and pulmonary tuberculosis, though Thorel (1896) and Zanelli (1931) have recorded cases in which these two conditions were probably present.It is of interest to observe that the allied condition of talc granuloma has been reported, both in the U.S. and in the British literature (Mackey and Gibson, 1948; Walker, 1948; and Smith, 1948), as occurring in abdominal and gynaecological surgery, following the use of talc or French cha...

Little Albert: A neurologically impaired child.

“…The fluid was cultured and was clear of infection. Phenolphthalein dye was injected into the ven tricle, which produced "considerable reaction" (probably an anaphylactic reaction due to phe nolphthalein hypersensitivity; see International Agency for Research on Cancer, 2000; Kendall, 1954), but "no stimulants" such as adrenalin (i.e., epinephrine) were deemed necessary to resuscitate him. A second puncture into the lumbar (lower back) region of the spine fol lowed, and the cerebrospinal fluid (CSF) was assayed to determine the presence or absence of the dye (MMF, April 20, 1920).…”

Acute pancreatitis complicating excessive intake of phenolphthalein

“…While it is clear, therefore, that phenolphthalein does not exert a direct toxic action, the well-documented reports of skin reactions indicate that it is capable of producing a hypersensitivity reaction. Post-mortem examination of a fatal case of encephalitis after phenolphthalein ingestion (Kendal, 1954) showed haemorrhagic areas throughout the length of the intestine, in the kidneys, the liver and the brain. If hypersensitivity is to be dismissed, then the possibility of a direct toxic effect on the acini must be considered, as some of the drug finds its way into the bile by means of the enterohepatic circulation and can enter the pancreatic duct system.…”

“…Since that time, phenolphthalein has been widely employed as a cathartic. A number of side effects have been reported, including encephalitis (Kendal, 1954), vomiting with intestinal colic (Knox, 1958), epidermal necrolysis (Potter, 1960) and erythema multiforme (Baer and Harris, 1967). The complication of acute pancreatitis has not previously been reported.…”