Une hépatite aiguë grave au sévoflurane

Immunoallergic cytolytic hepatitis is a rare adverse event of volatile anesthetic agents. A 37-year-old woman with no previous medical or surgical history underwent uterine curettage for spontaneous miscarriage under general anesthesia with sevoflurane. Two days after surgery, she developed abdominal pain, fever and jaundice. On the tenth postoperative day, laboratory tests revealed liver failure (LF). Severe sevoflurane hepatotoxicity was proposed due to the absence of any other causes for LF and to the presence of acute hepatitis with bridging pattern at the hepatic biopsy. The patient's clinical and biological condition worsened despite steroid therapy leading to emergency liver transplantation (LT). The liver's pathology examination observed acute hepatitis with massive multilobular hepatocellular necrosis, compatible with a toxic etiology. The patient died two months after LT from a multiple organ failure triggered by septic shock of undetermined origin. Immunoallergic cytolytic hepatitis is theoretically not caused by sevoflurane. This case report and others in the literature tend to demonstrate the existence of this toxicity although the underlying pathophysiology remains unclear.