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).