A case of chronic hepatitis B merged with acute fatty liver of pregnancy with severe coagulopathy

Risa Fukushima,Kotoe Kamata,Fumiko Ariyoshi,Minoru Nomura,Makoto Ozaki,Masashi Yanaki

doi:10.1186/s40981-018-0219-5

Risa Fukushima, Kotoe Kamata + Show 4 more

Open Access

https://doi.org/10.1186/s40981-018-0219-5

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Journal: JA clinical reports	Publication Date: Jan 7, 2019
Citations: 5	License type: open-access

Affiliation: Tokyo Women's Medical University

Abstract

BackgroundAcute fatty liver of pregnancy (AFLP) is a life-threatening disorder, and its relevance to viral hepatitis B (HB) remains unknown. This case presents an initial experience of treating a patient with HB progressing to AFLP throughout pregnancy; anesthesiologists should also recognize its clinical feature for perioperative management.Case presentationA 28-year-old parturient was diagnosed as chronic HB (CHB) at 21 weeks gestation. Liver and kidney dysfunction appeared rapidly at 34 weeks gestation, suspected as acute exacerbation of either CHB or AFLP. Emergency cesarean section was carried out, after which maternal disseminated intravascular coagulation and hypothermia persisted. With multidisciplinary management, the patient and infant were discharged on postpartum days 64 and 12, respectively.ConclusionsActive CHB develops into AFLP. Antiviral therapy should be considered for parturient patients with CHB, particularly for those with high viral load. The most favorable outcome is prompt and accurate diagnosis to establish suitable termination method.

Highlights

Acute fatty liver of pregnancy (AFLP) is a life-threatening disorder, and its relevance to viral hepatitis B (HB) remains unknown
Antiviral therapy should be considered for parturient patients with chronic HB (CHB), for those with high viral load
These clinical features may be supportive in distinguishing between viral hepatitis, fulminant hepatitis (FH) and AFLP

Summary

Introduction

Acute fatty liver of pregnancy (AFLP) is a life-threatening disorder, and its relevance to viral hepatitis B (HB) remains unknown. This case presents an initial experience of treating a patient with HB progressing to AFLP throughout pregnancy; anesthesiologists should recognize its clinical feature for perioperative management. Fulminant hepatitis (FH), a type of viral infection, shares a number of similar clinical features Both diseases occur mainly in late pregnancy and manifest with jaundice, liver dysfunction, and rapidly progressing severe coagulopathy [3, 6].

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Conclusion