American Journal of Case Reports最新文献

{"title":"Diagnostic and Therapeutic Challenges in an Acute Variegate Porphyric Crisis Complicated by Anuric Renal Failure and Multiorgan Dysfunction: A Case Report.","authors":"Peter B Conroy, Sue Davel, Jacques A J Malherbe, Simon J Carrivick, Edward N Briggs","doi":"10.12659/AJCR.946969","DOIUrl":"https://doi.org/10.12659/AJCR.946969","url":null,"abstract":"<p><p>BACKGROUND Acute porphyrias arise from genetic defects in heme synthesis. Significant increases in urine porphobilinogen (PBG) levels are diagnostic, enabling further testing and the commencement of targeted therapies. We report a rare case of an elderly woman with a delayed diagnosis of acute variegate porphyria (VP) neurovisceral crisis, anuria, and multiorgan failure precipitated by methicillin-sensitive Staphylococcus aureus (MSSA) sepsis. Diagnostic and therapeutic difficulties confirming an acute VP crisis in the anuric patient are explored. CASE REPORT A 77-year-old South African woman presented with undifferentiated MSSA sepsis. Despite escalation to intensive care and treatment of her infection, she developed encephalopathy, tetraparesis, autonomic dysfunction, and anuric renal failure, requiring renal replacement therapy. Given her anuric state, novel assays of the dialysate effluent were performed and revealed elevated PBG levels. Xanthochromic cerebrospinal fluid was also obtained. Taken together with confirmatory plasma porphyrin spectrography, an acute VP neurovisceral crisis with multiorgan failure was established. Intravenous heme-arginate combined with extracorporeal filtration via continuous renal replacement therapy and therapeutic plasma exchange were initiated. Inappropriate blood leak detector clamping occurred during extracorporeal filtration due to the presence of porphyrins in the effluent. Despite these aggressive measures, the patient died due to her illness. CONCLUSIONS Progressive neurological compromise, coupled with undifferentiated multiorgan failure, should prompt consideration of an underlying acute porphyric crisis. In anuric porphyria patients, PBG assays of extracorporeal circuit effluents may be of diagnostic value. Effluent PBGs can interfere with the extracorporeal circuit blood leak detector, thereby offering further clinical suspicion of an underlying acute porphyric crisis.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e946969"},"PeriodicalIF":1.0,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12046175/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Agenesis of the Dorsal Pancreas and Its Possible Link to Pancreatic Neuroendocrine Tumors: Case Insights.","authors":"Alessia Fassari, Edoardo Rosso, Jyoti Lakshmi Anafack, Vito De Blasi","doi":"10.12659/AJCR.947512","DOIUrl":"https://doi.org/10.12659/AJCR.947512","url":null,"abstract":"<p><p>BACKGROUND Agenesis of the dorsal pancreas (ADP) is a rare congenital anomaly resulting from incomplete development of the dorsal pancreatic bud, affecting the body and tail of the pancreas. While often asymptomatic, it can present with clinical abnormalities such as abdominal pain, diabetes, or obstructive jaundice, and may be associated with chronic pancreatitis and tumors. We report the third documented case of a high-grade neuroendocrine tumor located at the head of the pancreas in a patient with complete ADP, along with a review of the literature. CASE REPORT An 86-year-old man presented with jaundice caused by a 3-cm pancreatic mass compressing the bile duct, confirmed through imaging to be associated with ADP. Surgical intervention was declined, and a combined laparoscopic and radiological approach was used to place a biliary stent, alleviating symptoms. Histopathological analysis confirmed a poorly differentiated neuroendocrine carcinoma (NEC). Despite initial symptomatic relief, the patient died due to complications 3 months later. CONCLUSIONS This report underscores the diagnostic challenges of ADP and its potential association with pancreatic neoplasms. Improved imaging techniques such as computed tomography (CT), magnetic resonance imaging (MRI), and endoscopic ultrasound (EUS) facilitate diagnosis and differentiation from similar conditions. The association between ADP and pancreatic tumors should warn us to be watchful with every patient diagnosed with ADP and focus on the early detection of possible malignancies. Further research is needed to clarify the genetic and developmental mechanisms linking ADP to tumorigenesis and to explore targeted therapeutic approaches.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e947512"},"PeriodicalIF":1.0,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12035965/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144001586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Capnocytophaga canimorsus from Dog Saliva Exposure Causing Severe Sepsis in a Healthy Adult: A Case Report.","authors":"Megan A Stephens, Nawras Silin, Tahani Dakkak, Sangamithra Sathian, Aditya K Ghosh, Hardeep Singh, Navneeth Bongu","doi":"10.12659/AJCR.946691","DOIUrl":"https://doi.org/10.12659/AJCR.946691","url":null,"abstract":"<p><p>BACKGROUND Capnocytophaga canimorsus is a gram-negative bacterium commonly found in the saliva of dogs and cats. It has the ability to evade the human immune system and cause life-threatening infections, particularly in immunocompromised individuals. C. canimorsus infection was first described in 1976, and additional cases have since been reported, with complications varying from mild to severe. This case report highlights the occurrence of a severe C. canimorsus infection in an immunocompetent patient, which rapidly progressed to septic shock and multiorgan failure. CASE REPORT We present the case of a 63-year-old man with no significant past medical history who presented with weakness, fatigue, and confusion. Further investigation revealed a wound on his lower right extremity, which had been licked by his dog. The causative pathogen was identified as C. canimorsus through blood culture and mass spectrometry. The patient experienced septic shock with multiorgan failure, including acute renal failure, liver failure, and coagulopathy. Prompt initiation of empirical broad-spectrum antibiotics prior to identification of the source of infection proved to be beneficial, resulting in clinical and symptomatic improvement for the patient. CONCLUSIONS This case emphasizes the severe complications that can arise from C. canimorsus infection in immunocompetent individuals, underscoring the importance of early recognition and treatment in cases of sepsis, particularly in those with potential dog saliva exposure.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e946691"},"PeriodicalIF":1.0,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12035970/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144028917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multiple Myeloma Presenting as Breast Metastasis: Diagnostic Challenges and Case Analysis.","authors":"Gloria Messina, Maria Antonia Fucile, Marianne Kupper, Marco Campitiello, Francesca Plastino, Pierre-Olivier Legros, Julie Egea, Philippe Carassou, Giampaolo Tortora, Raffaele Longo","doi":"10.12659/AJCR.945853","DOIUrl":"https://doi.org/10.12659/AJCR.945853","url":null,"abstract":"<p><p>BACKGROUND Extramedullary disease represents an aggressive form of multiple myeloma (MM), with breast secondary involvement being very rare. This localization makes differential diagnosis from primary breast cancer difficult, as clinical and radiological patterns are similar between these entities. CASE REPORT An 83-year-old patient, treated for immunoglobulin A (IgA) kappa, (1q21+) MM, diagnosed in April 2016, presented to the Emergency Department for a fall. Clinically, she presented with multiple, bilateral breast lesions, confirmed by mammography and magnetic resonance imaging (MRI). Histology analysis documented a tumor with a solid and discreetly trabecular architecture, without calcifications or ductal/lobular in situ lesions, nor peritumoral lymphatic or vascular invasion. The tumor cells were negative for hormonal receptors and human epidermal growth factor receptor 2 (HER2). This histological pattern was first mistaken for an aggressive, infiltrating, pleomorphic lobular primary breast carcinoma. However, because of the history of a concomitant MM and the discordance between the histological diagnosis showing a tumor with a triple negative phenotype and the immunohistochemical profile of the pleomorphic lobular breast cancer, which usually overexpresses hormonal receptors, a histological revision was undertaken, and this confirmed the diagnosis of a breast localization of MM as the tumor cells expressed IgA kappa and multiple myeloma oncogene 1 (MUM1), and were negative for AE1/AE3 cytokeratin. The patient started fifth-line chemotherapy, but her clinical condition quickly worsened, leading to her death in June 2023. CONCLUSIONS The particularity of this case relies on the rarity of extramedullary disease from MM. Its difficult diagnosis represents a clinical challenge, as does the complexity of its management, due to a lack of evidence-based medical data.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e945853"},"PeriodicalIF":1.0,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12035963/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144044671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Arm-Behind-the-Back Position for Breast Cancer Radiotherapy in Patients with Lupus Erythematosus and Shoulder Arthropathy: A Case Report.","authors":"Shoki Nakamura, Kota Fujii, Mami Sakai, Keisuke Sakai, Hideki Hanazawa, Keisuke Nishimura, Kenji Notohara, Kazushige Yamaguchi, Satoshi Itasaka","doi":"10.12659/AJCR.946674","DOIUrl":"https://doi.org/10.12659/AJCR.946674","url":null,"abstract":"<p><p>BACKGROUND When 3-dimensional conformal radiation therapy (3DCRT) for postoperative breast cancer is performed in the supine position, patients are required to raise their arms to spare the arms from the irradiation field. However, patients with collagen vascular disease can experience severe joint symptoms. CASE REPORT A 43-year-old woman with a history of systemic lupus erythematosus (SLE) 10 years ago received a diagnosis of invasive ductal carcinoma of the left breast. Breast-conserving surgery and sentinel lymph node biopsy were performed. The pathological stage was IA. Physical and immunological examinations indicated that SLE disease activity was stable preoperatively and postoperatively. She had difficulty holding her left arm in a raised position because of arthritis related to SLE and steroid therapy. For postoperative radiation therapy, we developed an arm-behind-the-back position, in which a platform was placed between the patient's body and couch. In this position, the patient's arm was lowered behind the back, such that the arm did not interfere with the irradiation field of 3DCRT. The treatment plan achieved an acceptable homogeneity index, low dose to the lungs and heart, and no problematic hotspots. Although the time required for position matching and irradiation tended to be longer than that in the regular supine position, scheduled irradiation was safely completed. Grade 2 radiation dermatitis was observed. The patient showed no signs of local recurrence or distant metastases after 15 months. No radiation pneumonitis was observed. CONCLUSIONS The ingenuity of positioning can achieve radiotherapy in patients with collagen vascular disease and shoulder joint symptoms.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e946674"},"PeriodicalIF":1.0,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12035967/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neonatal Congenital Myasthenic Syndrome Linked to CHAT Gene Variants: A Case Report and Treatment Insights.","authors":"Mohammed Rohi Khalil, Lone Walentin Laulund, Anna Julie Aavild Ploug, Ida Coordt Elle, Jesper Fenger-Groen","doi":"10.12659/AJCR.946839","DOIUrl":"https://doi.org/10.12659/AJCR.946839","url":null,"abstract":"<p><p>BACKGROUND Congenital myasthenic syndrome (CMS) is a rare inherited neuromuscular disorder characterized by muscle weakness and fatigue, often presenting at birth or early childhood. The condition arises from mutations affecting the neuromuscular junction, with an incidence of 1.5 to 9 per million. CMS is primarily classified into presynaptic, synaptic, and postsynaptic types, with mutations in the choline acetyltransferase (CHAT) gene responsible for 4% to 5% of cases. The CHAT gene encodes an enzyme vital for acetylcholine synthesis, a neurotransmitter essential for neuromuscular communication. Mutations in CHAT disrupt acetylcholine production, impairing signal transmission at the neuromuscular junction. This report aims to present a rare case of CMS and highlight the significance of early genetic diagnosis and treatment. CASE REPORT We present a rare case of a newborn girl with autosomal recessive CMS caused by compound heterozygous mutations in the CHAT gene: CHAT c.1679A>G and CHAT c.287-1G>C. Born prematurely at 31 weeks gestation, she presented with severe hypotonia, respiratory failure, and absent spontaneous movements. Genetic testing confirmed CMS. Initial treatment with oral pyridostigmine was ineffective, necessitating a switch to intravenous neostigmine, followed by continuous subcutaneous administration. This resulted in significant clinical improvement, including weaning off mechanical ventilation and achieving developmental milestones, with ongoing physiotherapy. CONCLUSIONS This case underscores the importance of early genetic testing in neonates with unexplained muscle weakness and respiratory failure. Early genetic diagnosis and personalized treatment with acetylcholinesterase inhibitors were key to the infant's recovery, highlighting the potential for positive outcomes even in severe CMS cases due to ChAT mutations.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e946839"},"PeriodicalIF":1.0,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12035968/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144028918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Telitacicept and Tacrolimus Synergy in Managing Refractory Primary Membranous Nephropathy: Case Insights.","authors":"Renwei Huang, Yuhe Yin, Zewen Zhao, Xiaoying Dong, Chao Chen, Haowen Lin, Yiming Tao, Siqi Peng, Sichun Wen, Bohou Li, Qiong Wu, Sijia Li, Ting Lin, Hao Dai, Feng Wen, Zhuo Li, Lixia Xu, Jianchao Ma, Shuangxin Liu, Zhonglin Feng","doi":"10.12659/AJCR.946727","DOIUrl":"https://doi.org/10.12659/AJCR.946727","url":null,"abstract":"<p><p>BACKGROUND Refractory primary membranous nephropathy (pMN), characterized by persistent proteinuria despite immunosuppressive therapy, is frequently associated with phospholipase A2 receptor (PLA2R) antibodies. Recent advancements have emphasized the effectiveness of biological agents, particularly the novel recombinant fusion protein telitacicept, in treating this condition. However, only a limited number of published studies have reported the use of telitacicept in pMN treatment. This report presents a case of a man with refractory pMN successfully treated with a combination of telitacicept and tacrolimus. CASE REPORT A 32-year-old man had persistent lower-extremity edema for 6 months, with high levels of proteinuria and PLA2R antibodies. Renal biopsy confirmed the diagnosis of stage III membranous nephropathy. Initial treatment with corticosteroids and cyclophosphamide showed limited efficacy. The addition of tacrolimus improved symptoms to some extent, but corticosteroids had to be discontinued due to ophthalmic complications. Tacrolimus monotherapy, however, failed to further reduce the levels of proteinuria. Subsequently, the addition of telitacicept significantly lowered both levels of proteinuria and PLA2R antibodies within 2 weeks. After 6 months of this revised treatment, PLA2R antibody results turned negative. CONCLUSIONS This case report suggests that the combination of telitacicept and tacrolimus is a promising therapeutic approach for management of refractory pMN, particularly when conventional treatments have proven ineffective. It also highlights the importance of monitoring treatment response by measuring PLA2R antibody levels. Further studies are needed to confirm the long-term efficacy of the combination of telitacicept and tacrolimus in treatment of refractory pMN.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e946727"},"PeriodicalIF":1.0,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12035964/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Asymptomatic Postpartum Bradycardia: A Case of Spontaneous Resolution in a 34-Year-Old Woman.","authors":"Nurliana Abd Nassir, Huzairi Sani, Mohd Hafidzudin Zainal Abidin, Nur Amirah Shibraumalisi","doi":"10.12659/AJCR.946560","DOIUrl":"https://doi.org/10.12659/AJCR.946560","url":null,"abstract":"<p><p>BACKGROUND Maternal bradycardia in the postpartum period, without evidence of heart failure, is rare and usually self-limiting. Maternal bradycardia lasts a few days at most, but requires clinical observation and investigations to exclude cardiac disease or the effects of vasoactive medications or anesthesia. This report describes the case of a 34-year-old woman with self-limiting postpartum bradycardia as an incidental finding at a routine day 15 postnatal check-up. CASE REPORT A 34-year-old woman, para 2, presented for her routine day 15 postnatal check-up following an uneventful vaginal delivery. She was asymptomatic but was noted to have bradycardia, with a heart rate of 50 beats per min, confirmed by electrocardiogram as sinus bradycardia. Investigations, including blood tests, 24-h Holter monitoring, and echocardiography, ruled out structural heart disease or other pathologies. She was treated conservatively, and her heart rate normalized spontaneously by 6 weeks postpartum. CONCLUSIONS This report highlights the condition of postpartum maternal bradycardia and shows the importance of clinical history, thorough investigations, and follow-up to guide appropriate management and avoid unnecessary interventions.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e946560"},"PeriodicalIF":1.0,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12035969/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Innovative Callus Release Technique for Closed Reduction in Old Fractures: Case Studies and Methodology.","authors":"Ahmed Mohamed Oun, Mansour M Aldhilan, Mohamed E Abdel-Wanis","doi":"10.12659/AJCR.946876","DOIUrl":"https://doi.org/10.12659/AJCR.946876","url":null,"abstract":"<p><p>BACKGROUND In modern limb fracture management, particularly in children, image-guided closed reduction and percutaneous fixation are commonly employed. However, for older, displaced fractures, achieving closed reduction may be challenging or even unfeasible, often necessitating open reduction, which carries a higher risk of complications. We utilized K wires to fragment the fibrous callus and facilitate callus fragmentation in 2 patients with old fractures. In both cases, successful fracture reduction was achieved using a closed technique, followed by percutaneous K wire fixation. CASE REPORT Patient 1 was a 10-year-old girl who presented 10 days after sustaining a fully displaced fracture of the left radial neck due to trauma. Closed reduction under general anesthesia was unsuccessful. We employed percutaneous K wires to fragment the fibrous callus at the fracture site, enabling successful reduction and subsequent fixation. Patient 2 was a 50-year-old woman who presented with a displaced fracture at the base of the proximal phalanx of the little finger, initially treated with closed reduction and cast immobilization. At a follow-up examination 2 weeks later, the fracture was found to be fully displaced. Attempts at closed reduction under ring block anesthesia were unsuccessful. A percutaneous K wire was utilized to fragment the fibrous callus, enabling successful reduction and fixation. CONCLUSIONS The technique of fibrous callus fragmentation and closed reduction, followed by percutaneous K wire fixation, offers an effective approach for managing neglected, displaced fractures of the radial neck and the proximal phalanx of the little finger. This method allows for closed reduction and internal fixation in these challenging peri-articular fracture locations.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e946876"},"PeriodicalIF":1.0,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12035962/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144043685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic Challenges in Acute Fatty Liver of Pregnancy: Fever as a Key Symptom in Case Series from Indonesia.","authors":"Wahyudi Wirawan, Adhi Pribadi","doi":"10.12659/AJCR.946614","DOIUrl":"https://doi.org/10.12659/AJCR.946614","url":null,"abstract":"<p><p>BACKGROUND Acute fatty liver of pregnancy (AFLP) is a rare and catastrophic disease in pregnancy. It is important to distinguish between pathogenic diseases that cause abnormal liver function tests during pregnancy and typical physiological changes. An AFLP diagnosis can be established using Swansea criteria. AFLP typically occurs in the third trimester of pregnancy or postpartum, with a median presentation of 35-37 weeks of pregnancy. AFLP is also an obstetrical and medical emergency that is characterized by rapid deterioration of the patient's condition. CASE REPORT We present 3 cases from a tertiary hospital in Indonesia. The Swansea criteria were met in all 3 cases. Our cases were specifically characterized by complaints of fever. Fever complaints were not included in the Swansea criteria. The complaint of fever served to deceive and disorient the first treating clinician, resulting in a late referral. Delay of referral can lead to inappropriate treatment, prolonged duration of recovery, and the emergence of various complications, even death. In all of the cases reported here, the patients experienced detrimental effects and outcomes of the maternal and fetal condition. This case report also confirms that fever was the main symptom experienced by the patients who were hospitalized. Other common initial symptoms were nausea, vomiting, jaundice, and encephalopathy. CONCLUSIONS We propose that fever complaints be considered as criteria for AFLP diagnosis in Indonesia. However, more research is still needed with a larger number of cases. Prompt and appropriate treatment will result in a significantly more favorable outcome. Prompt identification, early diagnosis, immediate delivery, and comprehensive supportive treatment are important for maternal and infant outcomes in patients with AFLP.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e946614"},"PeriodicalIF":1.0,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12021003/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144020323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}