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ANESTHETIC PHARMACOLOGY

Desflurane Hepatitis Associated with Hapten and Autoantigen-Specific IgG4 Antibodies

James S. Anderson, MD^*, Noel R. Rose, MD, PhD, Jackie L. Martin, MD, Edmond I. Eger, MD^||, and Dolores B. Njoku, MD

From the *Anesthesia Consultants Associated, El Paso, Texas; Department of Pathology, W. Harry Feinstone Department of Molecular Microbiology and Immunology, and Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland; and ||Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California.

Address correspondence and reprint requests to Dr. Dolores Njoku, Departments of Anesthesiology and Critical Care Medicine and Pathology, Johns Hopkins Medical Institutions, 600 North Wolfe Street, Blalock 906A, Baltimore, MD 21287. Address e-mail to dnjoku{at}jhmi.edu.

BACKGROUND: Three cases of drug-induced liver injury (DILI) have been reported after desflurane anesthesia. However, no previous reports have detected serum autoantibodies such as that reported with DILI from halothane or isoflurane.

METHODS AND RESULTS: We describe the first documentation of cytochrome P450 2E1 IgG4 autoantibodies, as well as 58 kDa endoplasmic reticulum protein and trifluoroacetyl chloride hapten-specific IgG4 antibodies, in a patient who developed DILI after desflurane anesthesia.

CONCLUSIONS: These findings suggest that allergic and autoimmune mechanisms have critical roles in the development of desflurane DILI.

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999