The clinical manifestations of toluene embryopathy in 18 infants with a history of in utero exposure are reported from the Department of Pediatrics, University of Arizona College of Medicine, Tucson, and Maricopa Medical Center, Phoenix, AZ. Mothers were regular abusers of solvents and the fetus was exposed to toluene by maternal spray paint sniffing. Nine of the infants had been exposed to alcohol in addition, but except for an increased incidence of prenatal microcephaly, the resultant phenotype was unchanged. Premature birth occurred in 39%, and 9% died, 54% were small for gestational age, 52% had postnatal growth deficiency, 33% prenatal microcephaly, 67% postnatal microcephaly, 80% developmental delay, and 83% had craniofacial features similar to the fetal alcohol syndrome. Micrognathia, small palpebral fissures, and abnormal ears were most frequent with toluene, whereas the thin upper lip, smooth philtrum, and small nose were more common with alcohol exposure. Other less prominent features common to both toluene and alcohol embryopathies were nail hypoplasia, abnormal muscle tone, hemangiomata, renal anomalies, and altered palmar creases. [1]

COMMENT. It is estimated that 3 to 4% of teenagers engage in paint or glue sniffing. Toluene is the active organic solvent. It is an underrecognized form of substance abuse with serious acute and chronic toxicities. Acute symptoms of toluene toxicity include dizziness, euphoria, headache, vomiting, vertigo, convulsions, and loss of consciousness, sometimes preceded by delirium. Chronic toluene abuse causes headache, muscle weakness, peripheral neuropathy, nervousness, anemia, petechiae, abnormal bleeding, bone marrow aplasia, irreversible encephalopathy, and renal tubular acidosis. Following an initial report of a “Fetal solvents syndrome” [2], the effects of toluene on the fetus have been described infrequently. This Arizona University study of a fetal toluene syndrome compares findings in their 18 patients with others in the literature and with the fetal alcohol syndrome. The authors conclude that the craniofacial teratogenetic effects of toluene and alcohol have a common mechanism.

An additional 6 cases of toluene embryopathy are reported from the Denver General Hospital, Colorado [3]. Only one was exposed to alcohol as well as toluene.