Dimethylacetamide-Associated Liver Injury in Workers: Clinical Patterns of Latency, Selective Occurrence, and Implications for Occupational Surveillance

OBJECTIVES: N,N-Dimethylacetamide (DMAc) is a widely used industrial solvent and recognized occupational hepatotoxicant. Human evidence, however, appears inconsistent: clinically oriented reports describe overt liver injury in selected workers, whereas large epidemiologic studies often report null or non-specific group-level biochemical findings. This review aimed to interpret these evidence streams with attention to latency, selective occurrence, recurrence after renewed exposure, and implications for occupational surveillance. METHODS: We conducted a structured critical review based on a systematic PubMed/MEDLINE search through 22 May 2026. Human occupational studies were qualitatively compared with attention to latency, selective occurrence, clinical course after exposure modification, recurrence after renewed exposure, and exposure findings. Of 22 records, 15 underwent full assessment and eight publications were included in the core synthesis. RESULTS: Clinically oriented reports and cohorts of newly exposed workers repeatedly described DMAc-associated liver injury during the early exposure period, often within the first several weeks to months, affecting only a subset of exposed workers. Several reports described recurrence or worsening after renewed exposure. In contrast, epidemiologic studies in established worker populations primarily evaluated group-level liver enzyme outcomes and did not provide sufficient case-level information to assess latency, recurrence, or clinically overt hepatitis as a pattern-defined event. CONCLUSIONS: Published evidence remains limited and heterogeneous and does not establish DMAc-associated hepatotoxicity as a definitive idiosyncratic entity. Nevertheless, clinically apparent cases may require pattern-aware recognition, particularly during early exposure or renewed exposure. Population-level exposure control remains essential, but may be complemented by individual-level clinical vigilance.