Paul Klee (1879–1940), one of the most influential artists of the 20th century, died at 60 years of age from complications of systemic sclerosis (scleroderma). The precipitating event(s) of Klee’s scleroderma, as in most cases, will never be known. Among various potential factors, exposure to heavy metals, crystalline silica, and organic solvents—acting alone or in combination—can now be considered potential factors in the onset of Klee’s disease. By altering and modulating epigenetic determinants in a genetically susceptible host, these and other environmental factors may have led to perturbations of self-tolerance and inflammation culminating in Klee’s scleroderma.
De DeckerEVanthuyneMBlockmansD, et al. High prevalence of occupational exposure to solvents or silica in male systemic sclerosis patients: a Belgian cohort analysis. Clin Rheumatol2018; 37(7): 1977–1982.
5.
PedersenLMPerminH. Rheumatic disease, heavy-metal pigments, and the great masters. Lancet1988; 1(8597): 1267–1269.
6.
KleeF. Paul Klee. New York: George Braziller, 1962.
7.
MarieIGehannoJFBubenheimM, et al. Systemic sclerosis and exposure to heavy metals: A case–control study of 100 patients and 300 controls. Autoimmun Rev2017; 16(3): 223–230.
8.
MarieI. Systemic sclerosis and exposure to heavy metals. Autoimmun Rev2019; 18: 62–72.
9.
BramwellB. Diffuse scleroderma: its frequency, its occurrence in stone masons, its treatment by fibrolysin—elevations of temperature due to fibrolysin injections. Edinburgh Med J1914; 12: 387–401.
10.
ErasmusLD. Scleroderma in gold miners on the Witzwaterzrand with particular reference to pulmonary manifestations. S Afr J Lab Clin Med1957; 3(3): 209–231.
11.
RodnanGPBenedekTGMedsgerTAJr, et al. The association of progressive systemic sclerosis (scleroderma) with coal miners’ pneumoconiosis and other forms of silicosis. Ann Intern Med1967; 66(2): 323–334.
12.
HausteinUFZieglerVZschunkeE, et al. Progressive systemic sclerosis with silicosis in the German Democratic Republic. In: BlackCMMyersAR (eds) Systemic Sclerosis (Scleroderma). New York: Gower, 1985, pp. 138–142.
13.
BakstRKovarikCWerthVP. A case of localized scleroderma in a sculptor and his wife. J Clin Rheumatol2009; 15(8): 399–401.
14.
NietertPJSutherlandSESilverRM, et al. Is occupational organic solvent exposure a risk factor for scleroderma. Arthritis Rheum1998; 41(6): 1111–1118.
15.
GarabrantDHLaceyJVJrLaingTJ, et al. Scleroderma and solvent exposure among women. Am J Epidemiol2003; 157(6): 493–500.
16.
PartschS. Paul Klee 1879-1940. Köln: Benedikt Taschen Verlag, 1992.
17.
GrohmannW. Paul Klee. New York: Harry N. Abrams, 1955.
18.
BullS. Encyclopedia of military technology and innovation. Westport, CT: Greenwood Publishing Group, 2004, p. 53.
19.
HamiltonA. Dope poisoning in the making of airplanes. Monthly Rev U.S. Bureau Labor Stat1918; 6(2): 37–64.
20.
CzirjakLPocsESzegediG. Localized scleroderma after exposure to organic solvents. Dermatology1994; 189(4): 399–401.
21.
FeiningerJFeiningerL. Recollections of Paul Klee. 3rd ed. New York: Museum of Modern Art, 1946.
22.
MarieIGehannoJFBubenheimM, et al. Prospective study to evaluate the association between systemic sclerosis and occupational exposure and review of the literature. Autoimmun Rev2014; 13(2): 151–156.
