27
Volume 68 October 1975
647
Section of Dermatology President G C Wells FRCP
Meeting 19 December 1974
Cases Accidental Sensitization to 1-bromo-2, 4 dinitrobenzene D M Thompson MB MRCP (for C M Ridley MB FRCP) (Whittington Hospital, Archway Road, London N19) R A, aged 19. Schoolboy History: He spilt about 10 ml of 1-bromo-2, 4 dinitrobenzene in ethanol on his right forearm during a routine school chemistry experiment. This was washed off immediately but ten days later he developed intense erythema, edema and blistering in a linear distribution on his right arm (Fig 1). Over the next few days he developed similar lesions on palm of right hand and in finger webs of both hands. He was not aware of having come in contact with the sensitizing substance on his left hand. He improved with symptomatic therapy. Comment 1-bromo-2, 4 dinitrobenzene is closely related chemically to dinitrochlorobenzene (DNCB) and to dinitrofluorobenzene (DNFB), used because of their high sensitizing potentials as tests of competency of cell-mediated immune responses. Cross-sensitization occurs among these chemicals but not with the trinitrobenzenes. A similar reaction to DNFB was reported in a university chemical student (Ridley 1969). The halogen dinitrobenzenes split proteins and polypeptides and are used for amino acid sequencing in routine experiments as part of the advanced level syllabus of the Nuffield Foundation Chemistry Course in many school laboratories in this country and abroad. For the particular experiment carried out by the patient it was suggested that gloves should be worn but no indication of the dangers of the compound was given. The Teachers' Manual
Fig 1 Intense linear bulous eruption onforearm lists DNCB and DNFB as dangerous materials but does not mention skin sensitization among their hazards. Nevertheless to date no adverse reactions to these compounds have been reported to the organizers of the Nuffield Course. REFERENCE
Ridley C M (i 969) Contact Dermatitis News Letter 6, 1 i8
Dr D Sharvill I can complete this trio of accidental sensitizations. An undergraduate in his end-of-term examination had to separate and identify two un-, known organic chemicals. One was dinitrochlorobenzene. No warning was given that this might be hazardous. This chemical mixture was accidentally knocked over and fell on the exposed skin. Itching
648 Proc. roy. Soc. Med. Volume 68 October 1975
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and burning began in under twelve hours and a rash appeared in twenty-four hours. He was sent home untreated, and I did not see him until a week after the acciQent. At this stage he looked as if he had severe bullous pemphigoid, spreading well beyond the contaminated areas of skin. The patterning and streaking as in Dr Ridley's patient, were well marked, rather like dermatitis bullosa striata pratensis. He required in-patient treatment with systemic steroids and made a complete recovery. He had previously used various halogenated nitrobenzenes knowingly, but, being aware of the hazards, had taken great care and had not experienced any skin trouble.
Sezary Syndrome: Treatment by Leukophoresis R S-H Tan MRCP, C J Oon MRCP, A J Barrett MB and J P Hayes MRcPath (for P D Samman MD FRCP) (Westminster Hospital, London SWI) E F, woman aged 67
.. .................... R
History: Severe irritation and burning sensation of the skin for 31 years. Diffuse alopecia, now regrowing. She was presented to the Section in December 1973 as a case of Sezary syndrome. 2 Sezary cellfrom the skin infiltrate forming a She is presented again to show the improvement Fig T-cell rosette with sheep red cells. x 1000 in her skin after treatment by leukophoresis, and to demonstrate the nature of the abnormal cells electron beam. These treatments have produced in the skin infiltrate. Previous treatment has con- little benefit. sisted of full doses of the following drugs given in various combinations: prednisone, cyclo- On examination: Widespread erythema and phosphamide, procarbazine, bleomycin, ICRF cedema of the skin, nodules on the face, telangiec159. adriamycin and chlorambucil, and also the tasia and pupura on the trunk. Some areas of skin, notably the body folds and pressure areas, were remarkably spared.
M10'
Fig 1 Electron micrograph of Sdzary cellfrom the buffy coat. x 8000
Investigations: Peripheral blood: Total WBC, 7100-13 200/mm3 with up to 51 % Sezary cells seen since December 1973. Electron microscopy of buffy coat (Dr K Henry): many lymphoid cells with deeply cleft and folded nucleus typical of Sezary cells (Fig 1). Cytogenetic studies: aneuploid and polypoid chromosomes but no marker chromosomes. B cells 1 %, T cells 780% of circulating lymphocytes. No auto-antibodies detected. Skin infiltrate: 86 % of lymphoid cells infiltrating the skin formed spontaneous T-cell rosettes when incubated with sheep red cells; many of the cells had the typical cerebriform nucleus of Sezary cells (Fig 2). No immunoglobulin-bearing (B) cells were detected in the skin infiltrate. Skin histopathology: Nodule on face (August 1974) showed dense infiltrate of predominantly
Volume 68 October 1975
647
Section of Dermatology President G C Wells FRCP
Meeting 19 December 1974
Cases Accidental Sensitization to 1-bromo-2, 4 dinitrobenzene D M Thompson MB MRCP (for C M Ridley MB FRCP) (Whittington Hospital, Archway Road, London N19) R A, aged 19. Schoolboy History: He spilt about 10 ml of 1-bromo-2, 4 dinitrobenzene in ethanol on his right forearm during a routine school chemistry experiment. This was washed off immediately but ten days later he developed intense erythema, edema and blistering in a linear distribution on his right arm (Fig 1). Over the next few days he developed similar lesions on palm of right hand and in finger webs of both hands. He was not aware of having come in contact with the sensitizing substance on his left hand. He improved with symptomatic therapy. Comment 1-bromo-2, 4 dinitrobenzene is closely related chemically to dinitrochlorobenzene (DNCB) and to dinitrofluorobenzene (DNFB), used because of their high sensitizing potentials as tests of competency of cell-mediated immune responses. Cross-sensitization occurs among these chemicals but not with the trinitrobenzenes. A similar reaction to DNFB was reported in a university chemical student (Ridley 1969). The halogen dinitrobenzenes split proteins and polypeptides and are used for amino acid sequencing in routine experiments as part of the advanced level syllabus of the Nuffield Foundation Chemistry Course in many school laboratories in this country and abroad. For the particular experiment carried out by the patient it was suggested that gloves should be worn but no indication of the dangers of the compound was given. The Teachers' Manual
Fig 1 Intense linear bulous eruption onforearm lists DNCB and DNFB as dangerous materials but does not mention skin sensitization among their hazards. Nevertheless to date no adverse reactions to these compounds have been reported to the organizers of the Nuffield Course. REFERENCE
Ridley C M (i 969) Contact Dermatitis News Letter 6, 1 i8
Dr D Sharvill I can complete this trio of accidental sensitizations. An undergraduate in his end-of-term examination had to separate and identify two un-, known organic chemicals. One was dinitrochlorobenzene. No warning was given that this might be hazardous. This chemical mixture was accidentally knocked over and fell on the exposed skin. Itching
648 Proc. roy. Soc. Med. Volume 68 October 1975
28
and burning began in under twelve hours and a rash appeared in twenty-four hours. He was sent home untreated, and I did not see him until a week after the acciQent. At this stage he looked as if he had severe bullous pemphigoid, spreading well beyond the contaminated areas of skin. The patterning and streaking as in Dr Ridley's patient, were well marked, rather like dermatitis bullosa striata pratensis. He required in-patient treatment with systemic steroids and made a complete recovery. He had previously used various halogenated nitrobenzenes knowingly, but, being aware of the hazards, had taken great care and had not experienced any skin trouble.
Sezary Syndrome: Treatment by Leukophoresis R S-H Tan MRCP, C J Oon MRCP, A J Barrett MB and J P Hayes MRcPath (for P D Samman MD FRCP) (Westminster Hospital, London SWI) E F, woman aged 67
.. .................... R
History: Severe irritation and burning sensation of the skin for 31 years. Diffuse alopecia, now regrowing. She was presented to the Section in December 1973 as a case of Sezary syndrome. 2 Sezary cellfrom the skin infiltrate forming a She is presented again to show the improvement Fig T-cell rosette with sheep red cells. x 1000 in her skin after treatment by leukophoresis, and to demonstrate the nature of the abnormal cells electron beam. These treatments have produced in the skin infiltrate. Previous treatment has con- little benefit. sisted of full doses of the following drugs given in various combinations: prednisone, cyclo- On examination: Widespread erythema and phosphamide, procarbazine, bleomycin, ICRF cedema of the skin, nodules on the face, telangiec159. adriamycin and chlorambucil, and also the tasia and pupura on the trunk. Some areas of skin, notably the body folds and pressure areas, were remarkably spared.
M10'
Fig 1 Electron micrograph of Sdzary cellfrom the buffy coat. x 8000
Investigations: Peripheral blood: Total WBC, 7100-13 200/mm3 with up to 51 % Sezary cells seen since December 1973. Electron microscopy of buffy coat (Dr K Henry): many lymphoid cells with deeply cleft and folded nucleus typical of Sezary cells (Fig 1). Cytogenetic studies: aneuploid and polypoid chromosomes but no marker chromosomes. B cells 1 %, T cells 780% of circulating lymphocytes. No auto-antibodies detected. Skin infiltrate: 86 % of lymphoid cells infiltrating the skin formed spontaneous T-cell rosettes when incubated with sheep red cells; many of the cells had the typical cerebriform nucleus of Sezary cells (Fig 2). No immunoglobulin-bearing (B) cells were detected in the skin infiltrate. Skin histopathology: Nodule on face (August 1974) showed dense infiltrate of predominantly
