Acute Fatty Liver of Pregnancy From 18 Weeks’ Gestation

Two Fatty Liver Conditions Masquerading as Autoimmune Hepatitis

“…A separate cohort analysis found that 19% of AFLP cases had mutations in the MTP α-subunit responsible for LCHAD deficiency [13]. Most cases of AFLP occur in the third trimester or early postpartum period, but there are case reports as early as the second trimester with the earliest reported case at 18 weeks of gestation [1][2][3][4][5][6]. Clinically, AFLP leads to liver failure but is also associated with renal failure, coagulopathy, hypoglycemia, encephalopathy, and multisystem organ failure [17][18][19]-all of which occurred in the presented case.…”

“…e pathophysiology remains unclear, but research has implicated defective mitochondrial fatty acid oxidation as a contributing factor. AFLP typically presents in the third trimester or early postpartum period, but rare cases have been described in the second trimester [1][2][3][4][5][6]. Diagnosis is usually based on the Swansea criteria [7] in conjunction with serologic and biochemical testing although liver biopsy can be performed under certain circumstances.…”

Second‐trimester acute fatty liver disease of pregnancy: A brief review of the literature and a case report

“…AFLP usually manifests during late third trimester at a mean of 36 weeks, 1,5 and up to 9.8% in the immediate postpartum period 26 . Nonetheless, several cases were identified during second trimester, 6,18,27–33 but interestingly, it has never been reported in first trimester 2 . Potential clinical risk factors include prior episode of AFLP in a previous pregnancy, 34 multiple gestations, 35 underweight (BMI of ≤20), 3 nulliparity 8 and carrying a male fetus 36 .…”

“…A search was performed in the PubMed and Google Scholar database for cases contracting AFLP before third trimester. We could identify nine compatible cases published in the English language with complete account of details (beside current case) 6,18,27–33 . Cases that were reported as a part of case series but lacking detailed description of individual patients were hence excluded from this review 3,26 (Table 1).…”

“… †Pooled rates of 10 cases with early AFLP (<28 weeks) 6,18,27–33 including current case compared to pooled rates of 513 case from 12 case series of late AFLP (≥28 weeks) 3,7,13,14,19,20,26,34,39,43,46,47 …”