Summary

We present an unusual cause of recurrent syncope in a man in his 50s. He worked as a metallurgist and suffered syncopal events in his poorly ventilated workshop. A detailed history revealed that he used several solvents and chemicals at work and often kept workplace windows closed; he also smoked cannabis in his workshop. Physical examination was unremarkable. Investigations for prior haematemesis had shown oesophageal varices, cirrhosis and portal hypertension. An electrocardiogram (ECG), 24 hour ECG and an echocardiogram were normal. Liver biopsy showed steatohepatitis and cirrhosis consistent with toxic metabolic injury. He was advised to improve ventilation in his work environment following which he had no further episodes. The episodes of syncope were diagnosed to be secondary to effects of solvent inhalation compounded by effects of cannabis in a poorly ventilated workshop. This report illustrates the importance of eliciting an accurate social and occupational history in unusual cases.