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Immunological manifestations in paraphenylenediamine poisoning

Introduction

The classic physiopathologic approach of the manifestations after paraphenylenediamine (PPD) intoxication presents many limits. Recently, the immunogenic role of PPD (particularly its derivatives of oxidation) in the genesis of contact dermatitis and immunologic perturbations has been revealed. Our aim is to establish the immunologic profile of PPD-intoxicated persons based on monitoring of the inflammatory reaction.

Methods

A prospective study of 21 patients treated in the medical resuscitation unit in Ibn Rochd University Hospital of Casablanca due to PPD intoxication, realized during 2005. A follow-up of the demographic, clinical, paraclinical, therapeutic and evolutive parameters as well as valuation of the scores of gravity (SAPS II, APACHE II, OSF) was carried out in all our patients, and an inflammatory check-up including the white corpuscles, C-reactive protein, C3 and C4 fractions of complement and lymphocyte subpopulations CD3, CD4, CD8 and CD19 were realized for all of them. A follow-up was realized, and the kinetics compared with those of the clinical and paraclinical evolution of the patients.

Results

The monitoring of the inflammatory reaction in our patients shows evolution at three times for this reaction, with the first time of inflammatory stress during the first 3 days after the intoxication characterized by a relative immunodepression, the second time from the third day when the rhabdomyolysis exerts its proinflammatory power, and the third time (from the sixth day) corresponds to the immunomodulative action of PPD and to its oxidative metabolism. It is a systemic inflammatory reaction specific to a cytotoxic cell support, which would explain the secondary worsening of the clinical and paraclinical parameters of our patients (the nature of the state relative to hemodynamic shock, the cause of multivisceral failures, etc.).

Conclusion

It seems that the immunological aspect may present the answer to several questions that rhabdomyolysis alone could not answer. This study tried to establish a first immunologic profile of PPD-intoxicated persons, and to correlate it with their evolution.

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Charra, B., Hachimi, A., Benslama, A. et al. Immunological manifestations in paraphenylenediamine poisoning. Crit Care 12, P362 (2008). https://doi.org/10.1186/cc6583

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Keywords

  • Inflammatory Reaction
  • Contact Dermatitis
  • Lymphocyte Subpopulation
  • Immunological Aspect
  • Inflammatory Stress