Acute liver failure after whole body hyperthermia treatment

History and admission findings: A 49-year-old women with malignant neoplasi a had undergone whole body hyperthermia under sedation to a rectal temperat ure of 42.5 to 42.7 degrees C for about one hour. She failed to awaken afte rwards and was admitted in a coma and transferred to the intensive care uni t (ICU). There was slight improvement in consciousness in the following 30 hours. Investigations: Clinical and laboratory findings gave a constellation indic ating acute liver and renal failure (transaminases ca. 1400 U/l, bilirubin 7.27 mg/dl, serum creatinine 3.15 mg/dl, Quick thromboplastin time under 3. 5%, antithrombin III 57%, partial thromboplastin time 70.7 s, platelets 23 000/mu l). Other causes of acute liver failure, especially drug effects, an d septicaemia were excluded. Treatment and course: Treatment consisted of infusion of fresh plasma, neom ycin and lactulose by mouth, medication to prevent stress ulcer, and total parenteral nutrition which included branched-chain amino acids. The patient regained full consciousness on the regimen and on the 6(th) day after admi ssion was transferred to an ordinary ward. She was discharged after a furth er 3 weeks, by which time results of laboratory tests were practically norm al. Conclusion: The course of: the illness as well as the exclusion of any othe r cause of the acute liver failure in a patients who, 7 days before whole-b ody hyperthermia had been induced, had shown no signs of liver disease, mak es a causal relationship between the hyperthermia and the described abnorma lities highly probable. These serious, not previously reported, side effect s of whole-body hyperthermia treatment underline the importance of undertak ing this form of treatment only if strictest specific criteria are met.