title: Fatal hepatotoxicity after re-exposure to isoflurane: a case report and review of the literature.
abstract: A 76-year-old Caucasian woman developed fulminant hepatic necrosis 6 days after an uneventful operation under isoflurane anaesthesia. Laboratory findings included elevated bilirubin, grossly elevated transaminases and prolonged prothrombin time. Radiological investigation showed no evidence of extra-hepatic disease. Serological studies were negative for acute viral hepatitis and autoimmune disease. The patient may have been previously sensitized by exposure to isoflurane 3 years previously but antibodies to tri-fluoro acetate, present in 70% of cases of halothane hepatitis, were not detected in pre-operative or postoperative samples of blood. On the seventh postoperative day the patient died and postmortem examination demonstrated centrilobular necrosis of the liver, with a histological pattern similar to changes associated with halothane hepatitis.
authors.affiliation: Department of Health Care for the Elderly, Royal Victoria Hospital, Belfast, UK.
authors.forename: G B
authors.initials: GB
authors.lastname: Turner
authors.forename: D
authors.initials: D
authors.lastname: O'Rourke
authors.forename: G O
authors.initials: GO
authors.lastname: Scott
authors.forename: T R
authors.initials: TR
authors.lastname: Beringer
mesh_terms: D000368:Aged; D000671:Amputation, Surgical / Q000009:adverse effects / Q000379:methods; D000768:Anesthesia, General / Q000009:adverse effects* / Q000379:methods; D018685:Anesthetics, Inhalation / Q000008:administration & dosage / Q000009:adverse effects*; D056486:Chemical and Drug Induced Liver Injury; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007530:Isoflurane / Q000008:administration & dosage / Q000009:adverse effects*; D008099:Liver / Q000473:pathology; D008107:Liver Diseases / Q000473:pathology; D009336:Necrosis; D011184:Postoperative Period; D012086:Reoperation
chemical_list: D018685:Anesthetics, Inhalation; D007530:Isoflurane