Ifosfamide is an alkylating cytotoxic agent used in sarcomas and other solid organ tumours.The dose-limiting toxicities of ifosfarnide are myelosuppression and urotoxicity.Effects on the liver are infrequently seen, with a 3% incidence suggested by manufacturers.The authors report the development of acute liver failure with encephalopathy and coagulopathy occunring within 24 hours of completion of standard dose (3g/rn2/day for 3 days) ifosfamide in combination with doxorubicin, for the treatment of synovial sarcoma.It is the first definite report of acute liver toxicity with ifosfamide use [1].