N,N-dimethylformamide-induced acute hepatic failure: A case report and literature review

Abstract

N,N-dimethylformamide (DMF) is a major solvent predominantly used in the chemical industry. The main toxic effects following exposure to DMF are gastric irritation, skin eruption and hepatotoxicity. However, hepatic failure induced by DMF is rare. In this report, we present a case of acute hepatic failure following exposure to a toxic dose of DMF via respiratory tract inhalation and skin absorption with detailed abdominal computed tomography scan, sequential laboratory data and polymorphisms. The patient recovered satisfactorily following artificial liver support therapy and pharmacological agents to protect the liver in addition to plasma, blood platelet and albumin transfusions. In view of the high mortality rate and rare occurrence rate of acute hepatic failure, the clinical characteristics, polymorphisms and therapeutic strategy of DMF poisoning are discussed.

Keywords: N,N-dimethylformamide; abdominal computed tomography scan; acute hepatic failure; artificial liver support system; case report.

Figure 1.

GSTM1 and GSTT1 gene electrophoregram. Lane 5 was the marker (dl 2000). Lanes 1–4 are amplification products of GSTM1. The amplified fragment length of GSTM1 was 219 bp. The outcome was GSTM1-null genotype. Lanes 6–9 are amplification products of GSTT1. The amplified fragment length of GSTT1 was 459 bp (arrows). The outcome was a GSTT1-positive genotype. GSTM1, glutathione S-transferase mu-1; GSTT1, glutathione S-transferase theta-1.

Figure 2.

Abdominal CT scans of the patient. (A) Abdominal CT scan on day 5 after admission indicated liver deformation, shrinkage of the liver, border irregularity, a low-density shadow with border blurring (circle), ascites (arrows) and splenomegaly. (B) Abdominal CT scan on day 21 indicated that the size of the liver had recovered, ascites (arrows) were decreased and the low-density shadow (circle) was similar to the previous CT. (C) Abdominal CT on day 52, indicated that the low-density shadow (circle) had decreased and its border was clear, and ascites (arrows) were not present. (D) Contrast-enhanced CT scan on day 54 indicated hepatic cirrhosis, liver deformation, an infarction of the spleen (triangle) and an absence of ascites (arrows). Compared with previous CT scans, the low-density shadow was not evident. CT, computed tomography.