Annals of Occupational and Environmental Medicine

The Korean Society of Occupational & Environmental Medicine (대한직업환경의학회)
권호 표지

A Case of Amyotrophic Lateral Sclerosis in a Worker Treating Pesticide Wastes

농약 폐기물 취급 근로자에서 발생한 근위축성가측경화증 증례

  • Choy, Soon (Department of Occupational and Environmental Medicine, School of Medicine, Kosin University) ;
  • Kim, Jung-Won (Department of Occupational and Environmental Medicine, School of Medicine, Kosin University)
  • 최순 (고신대학교 의과대학 산업의학교실) ;
  • 김정원 (고신대학교 의과대학 산업의학교실)
  • Published : 2011.12.31
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Abstract

Backgrounds: Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease involving the motor neuron of the cerebrum, brain stem, and spinal cord. It has been suggested that various occupational or environmental agents could be a cause of ALS. We report upon a case of a person contracting ALS who experienced a long-time exposure to pesticides, implying that pesticides are probable causal agents of ALS. Case reports: The patient has been experiencing shoulder pain and limitation of movement that started abruptly about three years ago. Over time, these symptoms have become aggravated despite ongoing therapies including medication. After two years, he was diagnosed with ALS through electromyography, nerve conduction velocity and many laboratory tests at a university hospital in Seoul. His social and medical history was non-specific. The patient had worked for about 15 years at a waste disposal site and mainly destroyed glass bottles containing pesticides. During this period, his respiratory tract and skin were exposed to various raw pesticides without appropriate personal protective equipment. He did this job one or two times a week and worked for two or more hours without a break. Through an investigation into the patient's working environment, significant levels of dichlorvos, one of the organophosphates, were detected. Conclusions: The study results revealed that the patient was exposed to considerable doses of pesticides as opposed to men spraying pesticides. Although controversial, pesticide exposures have been associated with ALS. However, we suggest that in this case the possibility that these pesticide exposures acted as a causal agent for the diagnosed ALS based on plausible biological mechanisms and epidemiologic data.

배경: 근위축성가측경화증은 대뇌, 뇌간, 척수 내 운동 신경세포를 침범하는 신경퇴행성 질환이다. 직업, 환경적 위험인자로는 유기용제, 농약, 전자기장, 흡연, 외상, 과도한 육체활동 등이 제시되고 있다. 저자들은 장기간 농약에 노출된 근로자에게서 발생한 증례를 소개하고 농약과 근위축성가측경화증과의 관련성에 대해 고찰해보고자 한다. 증례: 환자는 3년 전부터 어깨통증과 운동제한, 이후 투약을 포함한 지속적인 치료에도 불구하고 증상의 호전은 없었다. 2년 후 서울 소재 대학병원에서 근전도, 신경전도검사, 각종 혈액검사를 통해 근위축성가측경화증으로 진단되었다. 사회력, 과거병력 그리고 가족력상 특이사항은 없었다. 환자의 직업상 약 15년간 폐기물 처리장에서 사용하고 남은 농약병을 수거, 파쇄하는 업무를 해왔다. 작업하는 동안 원액상태의 다양한 농약에 호흡기와 피부로 노출되었다. 작업주기는 주당 1~2회이며, 1회당 작업시간은 2시간 이상이었고 특별한 휴식시간 없이 지속했다고 한다. 작업당시 적절한 보호구의 착용은 없었고 과거의 작업환경을 재현한 측정으로 ALS의 원인물질로 추정되는 유기인제 계열 농약인 디디브이가 매우 높은 수준으로 검출되었다. 결론: 연구결과 환자는 농약살포자들과 비교하여 고농도의 농약에 노출된 것으로 추정되었다. 기존의 농약 노출과 해당 질병간의 발생간 연관성에 관한 연구, 그리고 발생기전에 대한 가설에 근거하여 저자들은 농약이 근위축성가측경화증의 원인으로 작용할 수 있을 가능성에 대해 제안하고자 한다.

Keywords

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