A detailed history will facilitate the diagnosis of chronic PCB poisoning. Pertinent information includes occupational histories of all household members as well as information on the patient.s medications and diet, including ethanol intake and sport fish consumption. During the physical examination, physicians should pay particular attention to the skin and hepatic systems. Encountering a patient with PCB toxicity should trigger consideration of whether this is a sentinel event, indicating the possibility of other similarly exposed persons such as co-workers or family members.
Chloracne is the only known overt sign of PCB toxicity; however, the absence of chloracne does not rule out exposure.
PCBs have very low potential for producing acute toxic effects. The only overt sign of PCB exposure is chloracne, which is described in the Dermatologic Effects section. Acneform lesions do not appear in all severely exposed patients, so the absence of chloracne does not rule out exposure. New cases of chloracne should be reported to the local or state health department.
Elevated liver enzymes are the most sensitive indicator of PCB exposure in animals, and alterations in AST (SGOT), GGT (GGTP), bilirubin, and albumin levels have been consistently reported in human epidemiologic studies. Hepatomegaly has also been noted in some PCB-exposed workers.
Signs of chronic exposure to PCBs are generally subtle, if present at all.
Many people who are chronically exposed to PCBs exhibit no overt signs or symptoms of toxicity. In persons with hepatic involvement, signs of PCB exposure can include weight loss, anorexia, nausea, vomiting, jaundice, and abdominal pain. Headache, dizziness, and edema have also been reported.
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