Tiny Tox Talk

Characteristics of Patients with No Underlying Toxicologic Syndrome Evaluated in a Toxicology Clinic

Counterpoint case: 47 y/o M with facial nerve neuritis

REsults:

• 18 (90%) patients describe a single self-limited toxic exposure
• 19/20 (95%) had a limited exposure dating 1 month to 6 yrs prior
• 16/20 (80%) reported inhalation exposure, with three reporting off-gassing of volatile chemicals
• 6/20 sought alternative medical therapy prior to toxicology evaluation
• 6/20 attempted litigation

Jerrold B. Leikin, MD, Mark B Mycyk, MD, Sean Bryant, MD, Kirk Cumpston, DO, and Stephen Hurwitz, MD

Discussion:

• Medical eval revealed no biologically plausible cause of symptoms; none followed an identifiable toxidrome
• Idiopathic environmental intolerance
• Patients had no past psych eval or documented history
• Psych ddx: somatic symptom disorder, delusional disorder, paranoid personality disorder
• Zilker describes similar cases, psychotherapy best treatment

methods:

• Retrospective case series

• Exclusion Criteria: clinical or laboratory confirmation of a toxicologic exposure and/or ongoing psychiatric illness or chemical-dependency issue

NONE of the patients accepted the clinic's inconclusive toxicological evaluation of their chronic symptoms.

Conclusion: Be careful going down an expensive rabbit hole with patients presenting like this.

Counterpoint case:

49 year old construction worker who stated he developed chronic left-sided facial pain, weakness, dystonia which he attributed to a 2 hr exposure to a light bulb several months earlier. What might have caused his symptoms?

Idiopathic Environmental Intolerance

Term used to describe a condition where people report a range of recurrent nonspecific physical and psychological symptoms and attribute them to exposure to low levels of a wide range of chemical, biological or physical agents in the everyday environment. Most of the patients in this study do not quite fit this bill because they had reported only one exposure, not an ongoing sensitivity.