The toxicological databases for
petroleum refinery products such as
mineral oils, as well as for their potential contaminants and additives, were reviewed for human cases of
poisoning by the oral route. The aim was to determine whether any overlooked adulterant in the oil implicated as the cause of the 1981 outbreak of Toxic Oil Syndrome (TOS) in Spain, may have been responsible for the unusual symptomatology characterizing this disease. The essential features of TOS were peripheral
eosinophilia, pulmonary oedema and endothelial damage in the acute phase;
myalgia, sensory neuropathy, hepatic injury, skin oedema and sicca in the intermediate phase; and
peripheral neuropathy, muscle wasting, scleroderma and hepatopathy in the chronic phase. Of the more than 70 chemical entities and mixtures reviewed here, none had been reported as producing adverse toxic effects upon ingestion resembling the specific set of symptoms and progression that characterized TOS. Because of their viscosity, the most commonly recorded disease process associated with oral ingestion of
petroleum refinery products was
lipid pneumonia, implicating lung exposure via aspiration. The
mineral oil additives and contaminants comprised a highly diverse range of chemical entities, producing a variety of symptoms in instances of
poisoning. Specifically, no chemical entity amongst the refinery products, additives or contaminants was described as inducing a syndrome involving
vasculitis accompanied by thrombotic events, along with immunological consequences (such as T-lymphocyte activation and
cytokine release), as is considered to be the cellular basis of TOS.