食道癌患者に認められた化学薬品が原因と考えられる抗赤血球自己抗体と輸血

Abstract

Here reported a case of esophageal cancer showing high level of anti-erythrocyte autoantibody of IgG type possibly caused by his professional long-term exposure to chemicals such as hydrogen fluoride, chloride and sulfuric acid.Case: Y. Y.,54 y. o., M.. He had been working as a house washer over twenty years using hydrogen fluoride, chloride and sulfuric acid as cleansers and bleaching agents, used to taste the mixtures of the chemicals in order to obtain the best ratio and condition of them. As he had been quite healthy since his birth, he had never used any medicines habitually, and had never received blood transfusion. On Apr.1983, he consulted our hospital, mainly complaining of dysphagia, and was diagnosed to be suffering from esophageal cancer (squamous cell carcinoma) by means of radiological and endoscopic examinations. Immunological tests detected high level of anti-erythrocyte autoantibody (IgG), i. e. positive direct and indirect anti-globulin tests using polyspecific and anti- IgG antiserum without addition of the chemicals, both his serum and eluate from his red cells showing panaggulutination against several panel cells of blood type O, and these antibodies were absorbed completely by his own red cells. None of other autoantibodies such as LE factor, anti-nuclear antibody and anti-DNA antibody were detected.For the operation to rem ove his cancer, concentrated human red blood corpuscles of 960ml in total were transfused to him, although pretransfusion cross match tests between these CRCs and his blood yielded incompatible results. The transfusion seemed not to be sufficiently effective, and caused a slight elevation of seral GOT, GPT and indirect bilirubin, suggesting extravascular hemolysis, for about two weeks thereafter, although no remarkable clinical side effects such as fever or renal dysfunction were recognized.About ten mon ths after the operation, while pulmonary metastases of the cancer occurred, the anti-erythrocyte autoantibody titers in his eluate and serum went down. During these ten months, he had never been exposed to these chemicals.The observation of this case sugges ts that a long-term oral exposure to the chemicals such as hydrogen fluoride, chloride and sulfuric acid might cause esophageal cancer, and on the other hand, it might cause production of anti-erythrocyte autoantibody. Hitherto, no papers reporting such cases as ours could be found in the literature. It should be necessary to pile up such cases, in order to provoke hygienical and experimental researches which may result the establishment of the concept of an occupational disease newly found.