An atypical presentation of acute fatty liver of pregnancy

Acute fatty liver of pregnancy (AFLP) is an uncommon but life-threatening condition unique to pregnancy, affecting ~1 in 10 000 pregnancies, and is the most common cause of liver failure in pregnancy. Here the case is described of a 35-year-old patient who presented at 21 weeks’ gestation complaining of vomiting, epigastric pain and food intolerance. During the course of her hospital stay of 31 days, she developed electrolyte imbalances and derangement in liver functions, with coagulopathy and bicytopenia. While she was being investigated for the cause of the biochemical abnormalities, she developed sepsis and anasarca, with a deterioration of her general condition, and it was decided to eliver the fetus. A diagnosis of AFLP was made on histological evaluation of a liver biopsy performed 3 days prior to delivery.