Acute Fatty Liver of Pregnancy Presenting as Fulminant Hepatic Failure: An Uncommon Disease

Acute Fatty Liver of Pregnancy (AFLP), though rare, is an obstetric emergency which carries a high incidence of maternal and perinatal mortality, despite optimal care. It is a catastrophic disease affecting women in the third trimester of pregnancy or in the post-partum period. It is usually a diagnosis of exclusion and requires a strong index of suspicion for a timely diagnosis and prompt intervention. We report a case of 24-year-old prime at 34- week gestation, presented with malaise, nausea, vomiting, jaundice, disorientation and absent fetal movements. Intrauterine death of fetus occurred. Supportive management in an intensive care unit resulted in successful outcome. By this case report we once again wish to emphasize the value of a timely diagnosis with a high level of clinical suspicion and supportive laboratory investigations including imaging; the need for early termination of pregnancy; and adequate supportive care as the key management options for AFLP. Further, we wish to explore the current treatment options available for AFLP and discuss a few novel therapeutic strategies such as plasma exchange in treating such cases and the pros and cons associated with these treatment modalities.