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

Eur J Gastroenterol Hepatol. 2000 Aug;12(8):955-9. doi: 10.1097/00042737-200012080-00017.


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.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Aged
  • Amputation, Surgical / adverse effects
  • Amputation, Surgical / methods
  • Anesthesia, General / adverse effects*
  • Anesthesia, General / methods
  • Anesthetics, Inhalation / administration & dosage
  • Anesthetics, Inhalation / adverse effects*
  • Chemical and Drug Induced Liver Injury*
  • Fatal Outcome
  • Female
  • Humans
  • Isoflurane / administration & dosage
  • Isoflurane / adverse effects*
  • Liver / pathology
  • Liver Diseases / pathology
  • Necrosis
  • Postoperative Period
  • Reoperation


  • Anesthetics, Inhalation
  • Isoflurane