The 2-amino-5-chloro-N,3-dimethylbenzamide is a key intermediate in the synthesis of pesticides and pharmaceuticals. However, no literature currently exists on 2-amino-5-chloro-N,3-dimethylbenzamide poisoning in humans. This study aimed to reveal the health hazard of this chemical for humans and summarize the clinical characteristics of patients with occupational 2-amino-5-chloro-N,3-dimethylbenzamide poisoning. This observational study included four patients with 2-amino-5-chloro-N,3-dimethylbenzamide poisoning from June 2022 to July 2022. The entire course of the incidents was described in detail. Blood 2-amino-5-chloro-N,3-dimethylbenzamide concentrations were detected by a mass spectrometer. Hematoxylin and eosin staining was performed to assess liver injury, and immunofluorescence was used to evaluate hepatic mitophagy. The 2-amino-5-chloro-N,3-dimethylbenzamide powder (99% purity) entered the human body mainly the skin and respiratory tract due to poor personal protective measures. The typical course of 2-amino-5-chloro-N,3-dimethylbenzamide poisoning was divided into latency, rash, fever, organic damage, and recovery phases in accordance with the clinical evolution. Rash and fever may be the important premonitory symptoms for further organ injuries. The chemical was detected in the blood of all patients and caused multiple organ injuries, predominantly liver injury, including kidney, myocardium, and microcirculation. Three patients recovered smoothly after comprehensive treatments, including artificial liver therapy, continuous renal replacement therapy, glucocorticoids, and other symptomatic and supportive treatments. One patient survived by liver transplantation. The postoperative pathological findings of the removed liver showed acute liver failure, and immunofluorescence staining confirmed the abundance of mitophagy in residual hepatocytes. This study is the first to elaborate the clinical characteristics of patients with 2-amino-5-chloro-N,3-dimethylbenzamide poisoning. The chemical enters the body through the respiratory tract and skin during industrial production. The 2-amino-5-chloro-N,3-dimethylbenzamide poisoning causes multiple-organ dysfunction with a predominance of liver injury. Liver transplantation may be an effective option for patients with severe liver failure. The mechanisms of liver injury induced by 2-amino-5-chloro-N,3-dimethylbenzamide might involve abnormal mitochondrial function and mitophagy.

中文翻译：

---

2-氨基-5-氯-N,3-二甲基苯甲酰胺职业暴露的严重肝损伤和临床特征：病例系列


2-氨基-5-氯-N,3-二甲基苯甲酰胺是农药和药物合成的关键中间体。然而，目前尚无关于2-氨基-5-氯-N,3-二甲基苯甲酰胺导致人类中毒的文献。本研究旨在揭示该化学品对人体的健康危害，总结职业性2-氨基-5-氯-N,3-二甲基苯甲酰胺中毒患者的临床特征。这项观察性研究纳入了2022年6月至2022年7月期间发生的4名2-氨基-5-氯-N,3-二甲基苯甲酰胺中毒患者，详细描述了事件的整个过程。通过质谱仪检测血液中2-氨基-5-氯-N,3-二甲基苯甲酰胺浓度。苏木精和伊红染色用于评估肝损伤，免疫荧光用于评估肝线粒体自噬。由于个人防护措施不善，2-氨基-5-氯-N,3-二甲基苯甲酰胺粉末（纯度99%）进入人体，主要通过皮肤和呼吸道进入人体。 2-氨基-5-氯-N,3-二甲基苯甲酰胺中毒的典型病程根据临床演变分为潜伏期、皮疹期、发热期、器质性损害期和恢复期。皮疹和发热可能是进一步器官损伤的重要先兆症状。所有患者的血液中都检测到了这种化学物质，并导致多器官损伤，主要是肝脏损伤，包括肾脏、心肌和微循环。 3例患者经过人工肝治疗、持续性肾脏替代治疗、糖皮质激素等对症支持治疗等综合治疗后均顺利康复。一名患者通过肝移植存活下来。 切除肝脏术后病理结果显示急性肝功能衰竭，免疫荧光染色证实残留肝细胞中存在丰富的线粒体自噬。本研究首次详细阐述了2-氨基-5-氯-N,3-二甲基苯甲酰胺中毒患者的临床特征。该化学品在工业生产过程中通过呼吸道和皮肤进入人体。 2-氨基-5-氯-N,3-二甲基苯甲酰胺中毒会导致多器官功能障碍，尤其是肝损伤。对于严重肝衰竭患者来说，肝移植可能是一种有效的选择。 2-氨基-5-氯-N,3-二甲基苯甲酰胺引起肝损伤的机制可能涉及线粒体功能异常和线粒体自噬。