Fatal hepatotoxicity after re-exposure to isoflurane: a case report and review of the literature

A 76-year-old Caucasian woman developed fulminant hepatic necrosis 6 days a fter an uneventful operation under isoflurane anaesthesia, Laboratory findi ngs included elevated bilirubin, grossly elevated transaminases and prolong ed prothrombin time. Radiological investigation showed no evidence of extra -hepatic disease. Serological studies were negative for acute viral hepatit is and autoimmune disease. The patient may have been previously sensitized by exposure to isoflurane 3 years previously but antibodies to tri-fluoro a cetate, present in 70% of cases of halothane hepatitis, were not detected i n pre-operative or postoperative samples of blood. On the seventh postopera tive day the patient died and postmortem examination demonstrated centrilob ular necrosis of the liver, with a histological pattern similar to changes associated with halothane hepatitis, (C) 2000 Lippincott Williams & Wilkins .