Document Type : Case Report

Authors

• Angelica dos Santos Vianna ¹
• Eric Slawka ²
• Margarida Lourenço Castelló ²
• Gabriel Machado Romão da Silva ²

¹ Instituto de Estudos em Saude Coletiva / Universidade Federal do Rio de Janeiro Hospital Universitario Clementino Fraga Filho / Universidade Federal do Rio de Janeiro

² Medical School, Rio de Janeiro Federal University, Rio de Janeiro, Brazil

Abstract

Introduction: Immune thrombocytopenia (ITP) is the most common cause of isolated thrombocytopenia in healthy people, and can be classified as either primary or secondary. Among the identifiable underlying causes is the use of drugs. Toluene is a widely used solvent and it is often contaminated with small amounts of benzene, a hematotoxic agent that can cause thrombocytopenia. Hereby, we reported a case of ITP in a patient with long-term low-level exposure to toluene in the workplace.
Case Report: A 34-year-old white female chemistry technician presented to a teaching hospital evaluation with a two-year history of isolated thrombocytopenia, diagnosed as ITP, and occupational low-level exposure to toluene for more than a decade. She had bruises on the physical exam, and platelets count of 40.000 µL. After investigation, a diagnosis of primary ITP aggravated by benzene-contaminated toluene exposure was made. The treatment included definitive removal from exposure and change of activities, with gradual improvement in clinical condition and platelets count, although without normalization.
Discussion: We addressed the role of benzene as a contaminant of toluene, and an aggravating agent of primary ITP, a multifactorial disease that arises from different mechanisms. Although several substances may cause ITP, little attention has been paid to the role of toxicants, such as benzene, a well-known hematotoxic agent.
Conclusion: Our case highlights the role of benzene-contaminated toluene in ITP. As benzene is a hematotoxic agent, we recommend that a proper health and environmental evaluation should consider benzene exposure in the workplace where toluene is used.

Keywords

• Toluene
• Benzene
• Occupational Exposure
• Purpura Thrombocytopenic
• Thrombocytopenia

Main Subjects

• Medical Toxicology