Introduction
Acute fatty liver disease of pregnancy (AFLP) is an uncommon condition compared to other causes of pathologies in the liver such as hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome.1 It is a life-challenging disease that has a high prevalence of about 1 to 3 cases per 10,000 deliveries occurring mostly at 36 weeks of gestation marked by fatty infiltration of the liver leading to hepatic failure.2 The management of AFLP is prompt delivery of a fetus with improvements being noticed after 1-2 days of delivery.3 Early diagnosis is necessary to ensure better maternal and fetal outcomes.4 Clinical findings in AFLP can vary, and diagnosis is further complicated due to significant overlap with the clinical and biochemical markers of HELLP syndrome.5 The main finding related to AFLP includes infiltration of hepatocytes with fats including the pericentral zone while sparing the periportal hepatocyte.6 A higher rate of mortality is observed in developing countries due to a shortage of capacity for intensive care. If AFLP is left untreated then jaundice can begin abruptly causing serious damage further progressing to fulminant hepatic failure and its associated complications.7 This is the stage where most of the AFLP is diagnosed.
To our knowledge, there is no case yet reported with the delivery of an alive fetus in a patient with AFLP at 26 weeks of gestation. Hence, we are presenting a case of a pregnant 27-year-old female with AFLP. She was delivered an alive male fetus due to prompt and early diagnosis despite being manifested with hepatic encephalopathy and disseminated intravascular coagulopathy (DIC).