Acute fatty metamorphosis of the liver associated with pregnancy

Ober, William B.; LeCompte, Philip M.

doi:10.1016/s0002-9343(55)80020-4

Cited by 84 publications

(18 citation statements)

References 13 publications

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“…Some steatosis is present during massive necrosis in any type of viral hepatitis (16). However, the conspicuous small-droplet steatosis accompanied by many macrophages and few lymphocytes in the parenchyma appears to be characteristic, and resembles pernicious steatosis in pregnancy (17) or after intravenous administration of large doses of tetracycline (18). Coupled with the lobular changes seen in one biopsy with chronic active hepatitis, it suggests that the initial lesion may be a cytopathic effect and not a lymphocytotoxic reaction (19) in keeping with previous claims for delta infections in Italy (5) and similar to some forms of hepatitis non-A, non-B (6).…”

Section: Transition To Cirrhosis (Four Autopsy Specimens Two Biopsy mentioning

confidence: 99%

Histologic Studies of Severe Delta Agent Infection in Venezuelan Indians

et al. 1983

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To supplement a detailed epidemiologic study of an outbreak of viral hepatitis in Venezuelan Indians in isolated valleys, apparently resulting from delta agent infection, 10 autopsy specimens were studied histologically and immunocytochemically, and five biopsy specimens were examined. The patients were children and young adults and predominantly males. A sequence of hepatitis from focal necrosis with conspicuous small-droplet steatosis, through massive necrosis, prolonged postnecrotic collapse to early cirrhosis with massive collapse was postulated. The histologic changes tentatively suggest a cytopathic effect of the delta agent without significant indication of lymphocytotoxicity, at least in the parenchyma. Delta agent was demonstrated in hepatocyte nuclei in moderate amounts in the focal-necrotic stage and in isolated cells in the massive-necrotic stage, but in large amounts during the transition to cirrhosis. Whether these patients, in whom neither HBcAg nor HBsAg were demonstrable in the liver, suffered exclusively from superinfection of hepatitis B virus carriers and/or coinfection of hepatitis B virus with the delta agent remains to be resolved. Delta infection may occur in isolated settings with no relation to Italian origin, drug addiction, or polytransfusion. The infection is far more widely spread than previously assumed.Six years ago in Italy, Rizzetto and coworkers (1) described the delta agent as a pathogenic factor complicating infection with hepatitis B virus (HBV). It is now thought to contain a small RNA genome surrounded by delta antigen and a coat of HBV surface antigen and to elicit a specific immune response which permits clinical diagnosis of delta infection. The delta agent requires coinfection with HBV for its replication which is associated with inhibition of synthesis of HBV markers. Delta antigen can be demonstrated immunohistochemically in hepatocellular nuclei (2, 3). Delta agent frequently occurs as a superinfection in HBV carriers with preexisting, sometimes minimal, degrees of histologic injury. In these persons, superinfection produces severe deterioration of the clinical and histologic picture often with fatal progression (4,5). Histologically, exacerbation

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Section: Transition To Cirrhosis (Four Autopsy Specimens Two Biopsy mentioning

confidence: 99%

Histologic Studies of Severe Delta Agent Infection in Venezuelan Indians

et al. 1983

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“…Early clinical signs are nausea and epigastric pain, symptoms easily interpreted as gastritis. As the disease progresses, many organs become involved and almost invariably gastrointestinal bleeding and se vere hypoglycemia occurs [5,9,10,15,21], This multiple organ failure can presumably be partly explained by concomitant disseminated intravascular coagulation (DIC) [8,14,16,17,20,31 ]. Thus, prompt treatment of occur ring DIC has been reported to reduce the high mortality rate related to acute hepatic failure [23].…”

Section: Introductionmentioning

confidence: 99%

Severe Acquired Antithrombin III Deficiency in Relation to Hepatic and Renal Insufficiency and Intrauterine Fetal Death in Late Pregnancy

Hellgren¹,

Hägnevik²,

Robbe³

et al. 1983

Gynecol Obstet Invest

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Acute fatty liver (AFLP) is a rare complication of late pregnancy. The maternal and fetal mortality has earlier been reported to be about 75 %, but during the last decade a reduced mortality to about 30 and 50%, respectively, has been reported in the literature. Disseminated intravascular coagulation (DIC) has been suggested as a contributing cause to the high mortality. The treatment of DIC has long been under debate, and recently the administration of antithrombin III (AT) concentrate in addition ot other supportive treatment has been reported successful. This paper presents the survival of 1 patient with severe liver and renal failure indicating AFLP complicated by severe disturbances in blood coagulation and fibrinolysis. The patient was treated with AT concentrate and small doses of heparin, blood coagulation factors, large amounts of glucose intravenously and supportive intensive care. The pregnancy was terminated by cesarean section. The child was stillborn and 75% of the placental parenchyma was fibrosed.

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“…Liver biopsy can help with definitive diagnosis-Ober and Lecompte in 1955 [16]. However, this method is less effective because of the risk of internal hemorhage due to confused clotting.…”

Section: Discussionmentioning

confidence: 99%

Case Report: Acute Fatty Liver of Pregnancy

Trang¹,

Tuyet²

2017

OJOG

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Acute fatty liver of pregnancy (AFLP) is a rare disease in Vietnam. Diagnosis by recorded literature is often difficult to distinguish from viral hepatitis, paraplegia, or bile duct disease, so AFLP diagnosis is often delayed. The prevalence of hepatitis B in Vietnam in pregnant women is estimated at 10% [1], preeclampsia is estimated at 0.2% [2]. A case pregnant woman has 35.5-week gestational age with AFLP, who was safely delivered both mother and infant at Hung Vuong hospital, Vietnam. A careful history and physical examination, in conjunction with compatible laboratory and ultrasound imaging results, are often sufficient to make the diagnosis, and liver biopsy is rarely indicated. Intensive adjuvant therapy and rapid birth control are essential for maternal and fetal outcomes.

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Acute fatty metamorphosis of the liver associated with pregnancy

Cited by 84 publications

References 13 publications

Histologic Studies of Severe Delta Agent Infection in Venezuelan Indians

Histologic Studies of Severe Delta Agent Infection in Venezuelan Indians

Severe Acquired Antithrombin III Deficiency in Relation to Hepatic and Renal Insufficiency and Intrauterine Fetal Death in Late Pregnancy

Case Report: Acute Fatty Liver of Pregnancy

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