Chronic, Recreational Chloroform-Induced Liver Injury

Area of Science:

• Toxicology
• Hepatology
• Organic Chemistry

Background:

• Chloroform, a halogenated hydrocarbon historically used as an anesthetic, is known for central nervous system depression, arrhythmias, and hepatotoxicity.
• Despite its discontinuation in clinical practice, accidental and intentional poisonings remain a concern.

Observation:

• A 26-year-old male graduate student presented with acute abdominal pain, dehydration, and jaundice.
• Initial investigations revealed extremely elevated liver enzymes (AST 13,527 U/L, ALT 8,745 U/L), with the cause of liver injury initially undetermined.
• The patient denied common ingestions but later admitted to chronic chloroform inhalation preceding his illness.

Findings:

• Chronic chloroform abuse was identified as the cause of severe, acute-on-chronic liver injury.
• The case demonstrates a delayed diagnosis due to the patient's initial non-disclosure of chloroform use.

Implications:

• Highlights the potential for severe hepatotoxicity from non-medical chloroform exposure.
• Underscores the importance of considering substance abuse, including inhalants, in cases of unexplained liver injury.
• Reinforces the need for thorough patient history and high index of suspicion for toxic exposures in clinical toxicology.