Acute Aflatoxin-Related Hepatitis Presenting as Unexplained Multi-Organ Failure in the Emergency Department

Acute aflatoxin-related hepatitis is rare and may go unrecognized due to nonspecific early symptoms and unreported dietary exposure. We describe a 63-year-old man who presented in critical condition with abdominal pain, vomiting and profound metabolic acidosis, alongside markedly elevated liver enzymes and signs of emerging multi-organ failure. Initial evaluation did not reveal any toxic ingestion, delaying diagnostic orientation. Only after admission, a more detailed history uncovered the consumption of spoiled lentils days before symptom onset, raising suspicion for acute aflatoxicosis. Supportive management, including glutathione therapy, led to full clinical recovery. This case underscores the need for careful dietary history in unexplained fulminant hepatic failure and highlights aflatoxin exposure as a potential but often overlooked cause, particularly when spoiled or imported foods are involved.