Acute cholestatic hepatitis after exposure to isoflurane.
OBJECTIVE
To report a case of acute cholestatic hepatitis following exposure to the inhalational anesthetic isoflurane.


METHODS
A 70-year-old healthy woman from Iraq developed acute cholestatic hepatitis 3 weeks following repair of the right rotator cuff under general anesthesia. There was no evidence for viral, autoimmune, or metabolic causes of hepatitis. No other medications were involved except for dipyrone for analgesia. The alanine aminotransferase was elevated to a peak concentration of 1533 U/L and the serum bilirubin reached a peak of 17.0 mg/dL. There was slow improvement over 4 months. Accidental reexposure by the patient to dipyrone was uneventful.


CONCLUSIONS
The clinical and histologic picture of this case resembles halothane hepatitis, which has a significant mortality rate.


CONCLUSIONS
Isoflurane, a common anesthetic agent, can cause severe cholestatic hepatitis.
Malnick
Stephen D H
SD
Department of Internal Medicine C, Kaplan Medical Center, Rehovot 76100, Israel. stevash@trendline.co.il
Mahlab
Keren
K
Borchardt
Jakob
J
Sokolowski
Nadia
N
Attali
Malka
M
D000111:Acetylcysteine / Q000627:therapeutic use; D000208:Acute Disease; D000368:Aged; D018685:Anesthetics, Inhalation / Q000008:administration & dosage / Q000009:adverse effects*; D001706:Biopsy; D056486:Chemical and Drug Induced Liver Injury / Q000188:drug therapy / Q000473:pathology*; D002779:Cholestasis / Q000139:chemically induced* / Q000473:pathology; D005260:Female; D006801:Humans; D007530:Isoflurane / Q000008:administration & dosage / Q000009:adverse effects*; D008099:Liver / Q000473:pathology*; D008111:Liver Function Tests; D014580:Ursodeoxycholic Acid / Q000627:therapeutic use
D018685:Anesthetics, Inhalation; D014580:Ursodeoxycholic Acid; D007530:Isoflurane; D000111:Acetylcysteine