The authors present a case of recurrent
acute liver failure because of occupational exposure to organic
solvents. A 35-year-old man with a 3-week history of worsening
jaundice and flu-like symptoms was admitted to our hospital. Viral
hepatitis serology and autoimmune factors were negative. The authors considered
liver transplantation, but the patient's liver function spontaneously recovered. Liver biopsy revealed massive infiltration of neutrophils, but the cause of the acute
hepatitis was not identified. Four months after discharge, the patient's liver function worsened again. The authors considered the possibility of
antinuclear antibody-negative
autoimmune hepatitis and initiated
steroid treatment, which was effective. Four months after discharge, the patient was admitted for repeated liver injury. The authors started him on
steroid pulse
therapy, but this time it was not effective. Just before the first admission, he had started his own construction company where he was highly exposed to organic
solvents, and thus the authors considered organic
solvent-induced
hepatitis. Although urine test results for organic
solvents were negative, a second liver biopsy revealed severe infiltration of neutrophils, compatible with
toxic hepatitis. Again, his liver function spontaneously improved. Based on the pathology and detailed
clinical course, including the patient's high exposure to organic
solvents since just before the first admission, and the spontaneous recovery of his liver damage in the absence of the exposure, he was diagnosed with
toxic hepatitis. The authors strongly advised him to avoid organic
solvents. Since then, he has been in good health without recurrence. This is the first report of recurrent
acute liver failure because of exposure to organic
solvents, which was eventually diagnosed through a meticulous medical history and successfully recovered by avoiding the causative agents. In
acute liver failure with an undetermined etiology, clinicians should rule out organic
solvent-induced
hepatitis.