SHM Converge Scientific Abstract ePoster Gallery-Toxicity at Home: Toluene and Formaldehyde Exposure as a Cause of Neuropathy

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This case report describes a 69-year-old man with severe, progressive peripheral neuropathy that began after he moved into a trailer home eight years earlier. His symptoms started as pain in a glove-and-stocking distribution in the distal extremities and gradually progressed proximally, leaving him unemployed and bed bound. His spouse developed milder but similar symptoms several years later, raising concern for a shared environmental cause.<br /><br />Testing found elevated formaldehyde and toluene levels in the trailer home, with urinary markers supporting exposure. Although his urinary metabolites did not prove overt toxic poisoning, the combination of chronic neurologic symptoms and similar symptoms in his wife suggested cumulative low-level environmental exposure as a possible contributor.<br /><br />The report reviews known effects of both chemicals: toluene can cause acute neurologic symptoms such as euphoria, ataxia, headaches, seizures, and respiratory depression, and chronic exposure may lead to CNS depression, cerebellar ataxia, and memory impairment. Formaldehyde exposure is associated with ocular and respiratory irritation, rashes, asthma, bronchitis, and increased leukemia risk.<br /><br />Treatment in this case was difficult. The patient’s neuropathic pain was refractory to multiple therapies, including IVIG, ketamine infusions, opioids, gabapentinoids, and other multimodal regimens. The main recommended intervention for both exposures is removal from the source, and the patient planned to seek alternate housing.<br /><br />The authors conclude that environmental exposures such as formaldehyde and toluene should remain on the differential diagnosis for unexplained neuropathy or cognitive symptoms, especially in manufactured or trailer homes. They emphasize that environmentally associated neurotoxicity may be underrecognized and challenging to treat, and further research is needed on the effects of low-level chronic exposure.

Asset Subtitle

Angel Padilla

Meta Tag

Author List Alex Wilkins, Angel Padilla, Christopher Yopp, Lara Voigt, Samuele Cicconetti

Category Clinical Vignettes

Concept Formaldehyde

Concept Toluene

Concept Peripheral Neuropathy

Concept Neurologic Symptoms

Concept Environmental exposure

Distinguished Non-Finalist

Presenter Organization University of Texas Health Science Center at San Antonio Joe R. And Teresa Lozano Long School of Medicine

Presenting Author Angel Padilla

Track Adult

Keywords

peripheral neuropathy

formaldehyde exposure

toluene exposure

environmental neurotoxicity

trailer home

chronic low-level exposure

neuropathic pain

glove-and-stocking distribution

toxic neuropathy

manufactured housing

Formaldehyde

Toluene

Peripheral Neuropathy

Neurologic Symptoms

Environmental exposure