An Industrial Outbreak of Toxic Hepatitis Due to Methylenedianiline

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Abstract
Between 1966 and 1972 hepatitis developed in 12 young male workers exposed to an epoxy resin 4, 4′diaminodiphenylmethane (methylenedianiline). This compound produces cholestasis and hepatic necrosis in many animals and caused the so-called Epping jaundice when 84 persons ate bread contaminated with it. The clinical pattern of the cases reported here resembled that in the earlier report: a short prodrome, severe right-upper-quadrant pain, high fever, and chills, with subsequent jaundice. All patients recovered by seven weeks. When re-examined nine months to 5 1/2 years later, all were in excellent health, without clinical or biochemical evidence of chronic liver disease. A 13th worker in another factory also had hepatitis after working with the compound; he may have inhaled toxic amounts, but circumstantial evidence in the 12 cases suggested that the skin was the major portal of entry. (N Engl J Med 291:278–282, 1974)