Advertisement

Virchows Archiv A

, Volume 397, Issue 3, pp 261–285 | Cite as

Pathology of a new Toxic Syndrome caused by ingestion of adulterated oil in Spain

  • F. J. Martinez-Tello
  • J. J. Navas-Palacios
  • J. R. Ricoy
  • R. Gil-Martín
  • J. M. Conde-Zurita
  • F. Colina-Ruiz Delgado
  • I. Tellez
  • A. Cabello
  • S. Madero-García
Article

Summary

The Toxic Syndrome (TS) caused by ingestion of adulterated rapeseed oil in Spain is a new disease of multisystemic character whose aetiology and pathogenesis remains unknown. The most prominent pathological feature is a peculiar non-necrotizing vasculitis, that affects mainly the intima and involves vessels of every type and size in practically every organ. The TS begins with an acute clinical picture with pleuropneumopathy, fever, headaches, exanthems and eosinophilia. In these early clinical phases the main pathological findings were observed in the lungs and consisted of intense pulmonary interstitial oedema with scanty inflammatory mononuclear infiltrates. Ultrastructural study revealed hydropic degeneration of pneumocytes types I and II with desquamation of type I. The patients in this phase died of respiratory failure, later deaths were due to thromboembolic complications. Later still the patients developped a neuromuscular syndrome, sclerodermiform skin lesions and severe weight loss and died predominantly of infectious complications and respiratory failure. The anatomopathological picture in the peripheral nerves was that of inflammatory neuropathy with a lymphocytic perineuritis that led to perineural fibrosis with secondary axonal degeneration. The muscle presented an interstitial inflammatory myopathy at first followed by a neurogenic muscular atrophy. The skin lesions in the late phases consisted in dermal or dermal and subdermal fibrosclerosis, with vasculitis of the small arteries in the lower dermis. The salivary glands and pancreas showed vasculitis and interstitial inflammation which progressed to interstitial fibrosis and parenchymal atrophy.

Key words

Toxic-oil syndrome Vasculitis Inflammatory myopathy Perineuritis Scleroderma 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Adams RD (1975) Diseases of the muscle, 3rd ed, Harper and Row, New YorkGoogle Scholar
  2. Asbury AK, Picard EH, Baringer JR (1972) Sensory perineuritis. Arch Neurol 26:302–312Google Scholar
  3. Bhawan J, Bachetta C, Joris I, Majno G (1979) A myofibroblastic tumor, Infantile digital fibroma (recurrent digital fibrous tumor of childhood). Am J of Pathol 94:19–36Google Scholar
  4. Bloch KJ, Buchannan WW, Whol MJ, Bunim JJ (1965) Sjögren's Syndrome a clinical pathological and sereological study of sixty-two cases. Medicine 44:187–231Google Scholar
  5. Boyd MR, Catignani GL, Sasame HA, Mirchell JR, Stiko AW (1978) Acute pulmonary injury in rats by nitrofurantoin and modification by vitamin E, dietary fat and oxygen. Am Rev Respir Dis 120:93–99Google Scholar
  6. Boyer JL (1978) Mechanisms of chlorpromazine cholestasis: Hypersensivity or toxic metabolite. Gastroenterology 74:1331–1332Google Scholar
  7. Brostoff J, Blanca M, Boulton P, Serrano P (1982) Absence of specific IgE antibodies in toxic oil syndrome. Lancet I:277Google Scholar
  8. Cannon PJ, Hassar M, Case DB, Casarella WJ, Sommers SC, Le Roy EC (1974) The relationship of hypertension and renal failure in scleroderma (progressive systemic sclerosis) to structural and functional abnormalities of the renal cortical circulation. Medicine 53:1–46Google Scholar
  9. Chusied MJ, Dale DC, West BC, Wolff SM (1975) The hypereosinophilic snydrome: Analysis of fourteen cases with review of the literature. Medicine 54:1–27Google Scholar
  10. Conn DL, Dyck PJ (1975) Angiopathic neuropathy in connective tissue diseases. In: Dyck PJ, Thomas PK, Lambert EH (eds) Peripheral neuropathy. WB Saunders Philadelphia, pp 1149–1165Google Scholar
  11. Corson JM (1972) The pathologist and the kidney transplant. In: Sommers C (ed) Pathology annual, Appleton Century Crofts, New York, pp 251–265Google Scholar
  12. Del Maestro RF (1980) An approach to free radicals in medicine and biology. Acta Physiol Scand (Suppl) 492:153–168Google Scholar
  13. Demopoulos HB, Flamm ES, Pietronigro DD, Seligman ML (1980) The free radical pathology and the microcirculation in the major central system disorders. Acta Physiol Scand (Suppl) 492:91–119Google Scholar
  14. Fajardo LF, Berthrong M (1978) Radiation injury in surgical pathology (Part 1) Am J Surg Pathol 2:159–199Google Scholar
  15. Fauci AS, Haynes BF, Katz (1978) The spectrum of vasculitis. Ann Intern Med 89:660–676Google Scholar
  16. Fauci AS, Harley JB, Roberts WC, Ferrans VJ, Gralnick HR, Bjornson BH (1982) The idiopathic hypereosinophilic syndrome: Clinical, pathophysiological and therapeutic considerations. Ann Intern Med (in press)Google Scholar
  17. Flaum MA, Schooley RT, Fauci AS, Gralnick HR (1981) A clinicopathologic correlation of the idiopathic hypereosinophilic syndrome. I. Haematologic manifestations. Blood 58:1012–1020Google Scholar
  18. Furst DE, Clemens PJ, Graze P, Gale R, Roberts N (1979) A syndrome resembling progressive systemic sclerosis after bone marrow transplantation. A model for scleroderma. Arthr Rheum 22:904–910Google Scholar
  19. Gilsanz (1982) Late features of toxic syndrome due to denatured rapeseed oil. Lancet I:335–336Google Scholar
  20. Gordon RM, Silverstein A (1970) Neurological manifestations in progressive systemic sclerosis. Arch Neurol 22:126–134Google Scholar
  21. Gordon RS (1981a) Little headway on toxic oil syndrome. Lancet II:1102Google Scholar
  22. Gordon RS (1981b) Oleanilides and spanish oil poisoning. Lancet II:1171–1172Google Scholar
  23. Gutierrez-Millet V, Navas-Palacios JJ, Gomez-Reino J, Fernandez Epifanio JL (1982) Renal involvement in toxic syndrome. Lancet I:1–20Google Scholar
  24. Harley DA, Goldman AL (1969) Pleuropneumonic reactions to nitrofurantoin. N Engl J Med 281:1087–1090Google Scholar
  25. Nofstad I (1974) Endothelial damage and platelet associated with PUFA-rich vit. E deficient diet fed to pig. Thromb Res 5:251–255Google Scholar
  26. Oh SJ (1980) Sarcoid polyneuropathy: a histologically proved case. Ann Neurol 7:178–181Google Scholar
  27. Pangalis GA, Moran EM, Rappaport H (1978) Blood and bone marrow findings in angioimmunoblastic lymphadenopathy. Blood 51:71–83Google Scholar
  28. Perez V, Schaffner F, Popper H (1972) Hepatic drug reactions. In: Popper H, Schaffner F (eds) Progress in liver disease, vol IV. Grune and Straton, New York, pp 597–625Google Scholar
  29. Porter KA (1974) Renal transplantation. In: Heptinstall RH (ed) Pathology of the kidney. 2nd ed, Little Brown and Co, Boston, pp 977–1041Google Scholar
  30. Reinhold HS, Buisman GH (1973) Radiosensitivity of capillary endothelium. Br J Radiol 46:54–57Google Scholar
  31. Report of the Pathology Commision of the Ministerio de Sanidad (1981 a) Brote epidémico de “Neumonía atípica”. Anatomía Patológica. Bol Epidemiol Sem 1486:161–162Google Scholar
  32. Report of the Pathology Commision of the Ministerio de Sanidad (1981 b) Informe de la Comisión de Anatomía Patológica del síndrome tóxico, sobre el material de biopsias realizadas. Bol Epidemiol Sem 1503:297–299Google Scholar
  33. Report of the Pathology Commision of the Ministerio de Sanidad (1982) Informe de la Comisión de Anatomía Patológica. Bol Epidemiol Sem (In press)Google Scholar
  34. Rodnam GP, Myerowitz RL, Justh GO (1980) Morphologic changes in the digital arteries of patients with progressive systemic sclerosis (scleroderma) and Raynaud phenomenon. Medicine 56:393–408Google Scholar
  35. Salerni R, Rodnan GP, Leon DF, Shaever JA (1977) Pulmonary hypertension in the CREST syndrome variant of progressive systemic sclerosis (scleroderma). Ann Intern Med 86:394–399Google Scholar
  36. Schooley RT, Flaum MA, Grabnick HR, Fauci AS (1981) A clinicopathologic correlation of the idiopathic hypereosinophilic syndrome. II Clinical manifestations. Blood 58:1021–1026Google Scholar
  37. Solis-Herruzo JA, Castellanos G, Colina F, Morillas JD, Muñoz Yagüe MT, Diaz Rubio C (1982) Hepatopatía en el síndrome tóxico por consumo de aceite adulterado en el área de Madrid. Gastroenterología Hepatología 5:113–124Google Scholar
  38. Spargo BH, Seymour AE, Ordoñez NG (1980) Renal biopsy pathology with diagnostic and therapeutic implication. John Wiley and Sons, New York, pp 254–265Google Scholar
  39. Spencer H (1977) Pathology of the lung. 3rd edn. Pergamon Press, OxfordGoogle Scholar
  40. Spielvogel RL, Goltz RM, Kersey JH (1977) Scleroderma-like changes in chronic graft versus host disease. Arch Dermatol 113:1424–1428Google Scholar
  41. Starmer GA, McLean S, Thomas J (1971) Analgesic potency and acute toxicity of substituted anilides and benzamides. Toxicol Appl Pharmacol 19:20–28Google Scholar
  42. Tabuenca JM (1981) Toxic-allergic syndrome caused by ingestion of rapeseed oil denatured with aniline. Lancet II:567–568Google Scholar
  43. Toxic Epidemic Syndrome Study Group. Hospital 1 ° de Octubre Madrid (1982) Toxic epidemic syndrome. Spain 1981. Lancet (in press)Google Scholar
  44. Umbert P, Winkelmann RK (1977) Histologic, ultrastructural and histochemical studies of granuloma annulare. Arch Dermatol 113:1681–1686Google Scholar
  45. Venge P, Dahl R, Hällgren R, Olsson J (1980) Cationic proteins of human eosinophils and their role in the inflammatory reaction. In: Mahmoud AA, Austen KF (eds) The eosinophil in health and disease. Grune and Stratton Inc. New York, pp 141–146Google Scholar
  46. Venge P, Dahl R, Hällgren R (1979) Enhancement of F XII — dependent reactions by eosinophil cationic protein. Thromb Res 14:641–649Google Scholar

Copyright information

© Springer-Verlag 1982

Authors and Affiliations

  • F. J. Martinez-Tello
    • 1
  • J. J. Navas-Palacios
    • 1
  • J. R. Ricoy
    • 1
  • R. Gil-Martín
    • 1
  • J. M. Conde-Zurita
    • 1
  • F. Colina-Ruiz Delgado
    • 1
  • I. Tellez
    • 1
  • A. Cabello
    • 1
  • S. Madero-García
    • 1
  1. 1.Departamento de Anatomía Patológica, Ciudad Sanitaria “1 ° de Octubre”Carretera de Andalucía KmMadrid-26Spain

Personalised recommendations