A series of 7 symptomatic patients who were employed in the aluminum industry were identified. They ranged in age from 19 to 65 years of age, all were male, and length of exposure to aluminum was from 1 to 35 years. The patients worked without protection and were exposure to dermal and respiratory contact to aluminum dust and shavings, as well as vaporized cutting oils. Each patient complained of recurrent sinus infections, chronic fatigue, motor and sensory losses, ataxia, vertigo, memory loss and chronic pain. Physical findings were sinus tenderness, ataxia, positive Romberg Sign, memory loss, fatigue, and signs of reactive airways dysfunction syndrome. All of the patients were disabled and unable to work due to their illness. All of the aluminum exposures were remote (longer that 3 months previously) and chronic (mean over one year exposure). Serum and urinary aluminum levels were not markedly elevated (7 to 30 μg per gram of creatinine in urine), but the patients all exhibited a positive chelation challenge test using DMSA (succimer) as the chelator. All had a positive clinical response to treatment with DMSA in the usual treatment regimen of 900 mg bid for 19 days. The ataxia, Romberg Sign, memory loss, fatigue and recurrent infections resolved with treatment. Two of the patients were able to return to full duty at work (with proper protection in place), others already had retirement and were able to start more active lifestyles.
Conclusion chronic and remote exposures to aluminum with toxicity may not be detected by elevated urinary and blood levels. Serum and urine levels of aluminum may decrease to “normal occupational ranges” in chronic and remote exposure cases. Chelation challenge testing may be valuable to help diagnose the chronic and remote aluminum toxicity cases. DMSA was useful as a clinical chelator for these cases of chronic and remote aluminum toxicity.
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