Short-term occupational hazard exposure at tire mechanic workshops can aggravate hepatic cirrhosis? A case report.

Background: Hepatocellular carcinoma (HCC) is malignancy of liver that usually occurs in patient with chronic liver disease and cirrhosis. In Indonesia, HBV was an endemic disease making about 60% of of HCC was related to HBV, on the other hand 20% was related to HCV. Hazard exposure in the workplaces may play roles to initiate the HCC. One of industries have higher risk of HCC is workers at mechanical workshop. Many mechanical workshop in Indonesia including small scale industry whom didn not implementation occupational health services.

Case presentation: Man, 31 years olds came with abdominal pain, and his belly became bigger in the last 2 weeks. These symptoms start gradually with mild pain that became heavier day after day, other symptoms are constipation, nausea, vomiting, chills, difficulty to breath, and his urine became darker. His relatives also realize that the patient skin became icteric. This patient did not have a history of liver disease or have diabetes and obesity. Based on examination: icteric eyes and skin, ascites, and hepato-splenomegaly. His bilirubin levels were 3.07 mg/dl for total, 2.29 mg/dl for direct, and 0,78 mg/dl for indirect. Based on imaging studies, USG has shown a mass on the right lobe of the liver, and, based on CT-scan, there was nodes on segments 6 and 7 on the liver. He recently works as tire repairs mechanic for 2 months, previously as a worker in the glass industry for 8 years of service. After a thorough analysis of his job, there were no risk factors as labor in the glass industry, but as a tire mechanic, he became exposed to lead that used in car/motor components and toluene from the rubber cement he used

Conclusion: The exposure of toluene through rubber cement may be related to aggravating his liver condition, and tough may be the main causes of his HCC was related to alcohol consumption. The management for return to work for this patient is quite difficult since his health prognosis is poor, making him is unfit for his current task. However, maybe after taking medication, therapy, and change of lifestyle, his condition may be better than right now to do some job that only requires light physical activities.