ACUTE FATTY LIVER OF PREGNANCY IN A PATIENT WITH CHRONIC ACTIVE HEPATITIS AND ASSOCIATED HEPATOCYTE ALPHA1-ANTITRYPSIN INCLUSIONS

Background: Acute fatty liver of pregnancy is a rare, potentially fata l condition that shares many of the signs and symptoms of severe preec lampsia. Early reports of this condition noted alarmingly high fetal a nd maternal mortality rates. However, recent reports have described mo re favorable outcomes due to prompt recognition and aggressive treatme nt. We here describe a patient with acute fatty liver of pregnancy sup erimposed on chronic active hepatitis. Case: A 27-year-old woman, para 0-1-2-1, presented at 36 weeks' gestation with a 2-week history of ma laise, nausea, emesis, diarrhea, and an 18-lb weight loss. The serum c oncentrations of transaminase enzymes, bilirubin, and alkaline phospha tase were increased, and a mild coagulopathy was present. The patient underwent repeat cesarean delivery and intraoperative needle biopsy of the liver. Histologic examination of the biopsy demonstrated the char acteristic changes of acute fatty liver of pregnancy and chronic activ e hepatitis with associated alpha1-antitrypsin hepatocyte inclusions. The serum alpha1-antitrypsin level was mildly elevated and the phenoty pe was normal (PiMM), excluding alpha1-antitrypsin deficiency. Viral a nd autoimmune etiologies for chronic hepatitis were excluded by labora tory studies. The woman experienced rapid resolution of symptoms and l aboratory abnormalities in the immediate postoperative period. Conclus ion: Acute fatty liver of pregnancy may occur in patients with underly ing chronic liver disease. Prompt delivery is necessary to reduce the risk of fetal and maternal mortality.