Acute Aflatoxicosis Resulting in Fulminant Hepatic Failure and Rhabdomyolysis

Background: Aflatoxins are known contaminants of foods. High dose exposure, particularly to Aflatoxin B₁ (AFB₁) 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 AFB₁ 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 AFB₁ in foods the patient consumed, and after alternate diagnoses' were sufficiently excluded. We conclude that chronic exposure to moderately elevated levels of aflatoxin B₁ may result in acute aflatoxicosis and fulminant hepatic failure.