Acute Aflatoxicosis Resulting in Fulminant Hepatic Failure and Rhabdomyolysis

BACKGROUND: Aflatoxins are known contaminants of foods. High dose exposure, particularly to Aflatoxin B(1) (AFB(1)) may cause acute aflatoxicosis. Outbreaks have been reported in developing nations but are virtually un-documented in the developed world. CASE REPORT: A 28 year old, healthy male presented with nausea, vomiting and abdominal pain. The patient deteriorated rapidly to a state of agitation and shock. The clinical picture, encephalopathy and laboratory results indicated fulminant hepatic failure, rhabdomyolysis and multi-system organ failure. Canned food the patient consumed almost exclusively contained AFB(1) at a level of 19.6 ppb. Alternate diagnoses were ruled out and a presumptive diagnosis of acute aflatoxicosis was made. After 45 days of intensive supportive therapy, the patient was discharged with no significant sequels. CONCLUSIONS: The diagnosis of aflatoxicosis was based on the clinical picture, the finding of high levels of AFB(1) in foods the patient consumed, and after alternate diagnoses' were sufficiently excluded. We conclude that chronic exposure to moderately elevated levels of aflatoxin B(1) may result in acute aflatoxicosis and fulminant hepatic failure.