Acute fatty liver of pregnancy showing microbial infection in the liver

A 24-year-old, nulliparous woman in her 30th week of pregnancy was admitted due to threatened premature delivery. Ritodrin chloride relieved the prema ture contraction of the uterus but jaundice and drowsiness appeared 7 weeks later. Laboratory data revealed disseminated intravascular coagulation (DI C) with intrahepatic cholestasis, and ultrasound examination showed fatty l iver. The patient was diagnosed with acute fatty liver of pregnancy (AFLP). Emergency delivery by Caesarean section was performed at 37 weeks of pregn ancy and the liver function and DIC improved immediately. Liver biopsy 13 d ays after delivery showed nuclear swelling and cytoplasmic ballooning with mild fatty deposition. These findings were relatively compatible with acute AFLP, Higher magnification and electron microscopy revealed intracytoplasm ic bacteria and fungus in the residual stage. The bacterial infection could be considered related to AFLP.