title: Acute Aflatoxicosis Resulting in Fulminant Hepatic Failure and Rhabdomyolysis.
abstract: BACKGROUND
  Aflatoxins are known contaminants of foods. High dose exposure, particularly to Aflatoxin B1(AFB1) may cause acute aflatoxicosis. Outbreaks have been reported in developing nations but are virtually un-documented in the developed world.
  
  
  METHODS
  A 28 year old, healthy male presented with nausea, vomiting and abdominal pain. The patient deteriorated rapidly to a state of agitation and shock. The clinical picture, encephalopathy and laboratory results indicated fulminant hepatic failure, rhabdomyolysis and multi-system organ failure. Canned food the patient consumed almost exclusively contained AFB1at a level of 19.6 ppb. Alternate diagnoses were ruled out and a presumptive diagnosis of acute aflatoxicosis was made. After 45 days of intensive supportive therapy, the patient was discharged with no significant sequels.
  
  
  CONCLUSIONS
  The diagnosis of aflatoxicosis was based on the clinical picture, the finding of high levels of AFB1in foods the patient consumed, and after alternate diagnoses' were sufficiently excluded. We conclude that chronic exposure to moderately elevated levels of aflatoxin B1may result in acute aflatoxicosis and fulminant hepatic failure.
authors.affiliation: Department of Internal Medicine B, Ziv Medical Center, Safed, Israel.
authors.forename: Nir
authors.initials: N
authors.lastname: Samuel
authors.affiliation: Intensive Care Unit, Ziv Medical Center, Safed, Israel.
authors.forename: Yosef
authors.initials: Y
authors.lastname: Ezri
authors.affiliation: Department of Internal Medicine B, Ziv Medical Center, Safed, Israel.
authors.forename: Raymond
authors.initials: R
authors.lastname: Farah
authors.affiliation: Department of General Surgery, Ziv Medical Center, Safed, Israel.
authors.forename: Vacksman
authors.initials: V
authors.lastname: Igor
authors.affiliation: Department of Emergency Medicine, Rebekka Ziv Medical Center, Safed, Israel.
authors.forename: Amer
authors.initials: A
authors.lastname: Hussein
authors.affiliation: Department of Internal Medicine B, Ziv Medical Center, Safed, Israel.
authors.forename: Orit
authors.initials: O
authors.lastname: Rubinshtein
authors.affiliation: Liver Unit, Ziv Medical Centre, Safed, Israel; Technion Institute, Faculty of medicine, Haifa, Israel.
authors.forename: Nimer
authors.initials: N
authors.lastname: Assy
keywords: Aspergillus; aflatoxicosis; aflatoxin; fulminant hepatic failure; rhabdomyolysis