Fatal isoflurane hepatotoxicity without re-exposure.

Isoflurane is less hepatotoxic than its predecessors, halothane and enflurane. We present a 68-year-old man who developed fulminant and fatal hepatic necrosis two days after open cholecystectomy done under isoflurane anesthesia. Laboratory findings included grossly elevated transaminases and bilirubin and prolonged prothrombin time. Serological studies were negative for viral hepatitis. Postmortem examination demonstrated centrilobular necrosis of liver.