Occupational Hydrocarbon Exposure Presenting as Acute Hepatocellular Injury with Atypical Mitotic Figures on Liver Histopathology in an Oil Rig Worker: A Case Report

Authors

• Hamzah Shariff, MD, Thomas Jefferson University HospitalFollow
• Maria Averbuch, DO, Thomas Jefferson University HospitalFollow
• Leanna Rucker, MD, Thomas Jefferson University HospitalFollow
• Madison Force, MD, Thomas Jefferson University HospitalFollow
• Dina Halegoua-De Marzio, MD, Thomas Jefferson University HospitalFollow

Abstract

Occupational exposure to hydrocarbons and aromatic solvents in the petroleum industry has been somewhat associated with hepatotoxicity, though the clinical manifestations and histologic features remain incompletely characterized. We present the case of a 33-year-old oil rig worker with prolonged occupational exposure to benzene and hydrocarbon compounds who presented with acute hepatocellular liver injury and concurrent biliary pathology. The patient presented with right upper quadrant pain, jaundice, and pale stools. Laboratory evaluation demonstrated marked hepatocellular injury with alanine aminotransferase (ALT) elevation to 1183 U/L and total bilirubin of 6 mg/dL. Extensive infectious, metabolic, and autoimmune evaluation was unrevealing. ANA and ASMA titers were 1:40 and considered non-specific. Imaging demonstrated cholelithiasis with distal common bile duct narrowing. The patient underwent endoscopic ultrasound–guided liver biopsy and endoscopic retrograde cholangiopancreatography (ERCP) with extraction of a fragmented stone and debris, complicated by post-ERCP pancreatitis. Liver biopsy demonstrated steatohepatitis with cholestasis and atypical mitotic figures without histologic evidence of autoimmune hepatitis or parasitic infection. Given the patient’s occupational exposure history and the absence of alternative etiologies, toxicant-associated liver injury was considered a potential contributor. Although hepatotoxicity from aromatic hydrocarbons has been described, reports of atypical hepatocellular mitotic activity remain scarce. This case highlights the importance of considering occupational exposures in the evaluation of acute liver injury while interpreting dysplastic changes on histopathology.

Recommended Citation

Shariff, MD, Hamzah; Averbuch, DO, Maria; Rucker, MD, Leanna; Force, MD, Madison; and Halegoua-De Marzio, MD, Dina (2026) "Occupational Hydrocarbon Exposure Presenting as Acute Hepatocellular Injury with Atypical Mitotic Figures on Liver Histopathology in an Oil Rig Worker: A Case Report," The Medicine Forum: Vol. 27, Article 18.
Available at: https://jdc.jefferson.edu/tmf/vol27/iss1/18