Abstract The clinical, laboratory and pathologic features of sixteen patients with liver of pregnancy are presented. Four of these patients survived. Twelve patients in this series were treated for acute pyelonephritis with large doses of tetracycline intravenously, but four who had not received tetracycline had hepatic lesions that were indistinguishable from those in patients with liver of pregnancy. Six nonpregnant women treated with tetracycline intravenously had similar changes in the liver. There was a high incidence of pathologic or functional involvement of the pancreas, kidneys and brain. Central nervous system changes are described, severe enough to be etiologically related to the stupor and coma noted in many patients with liver of pregnancy who had previously received tetracycline. The similarity in morphology of liver of pregnancy with that in experimental lesions produced by protein anabolism depressants, such as ethionine or essential amino acid deficient diets, is reiterated. Levels of nonesterified acids in the liver, although elevated above normal, are no greater than nonesterified acids in livers due to other causes. The possibility exists that the liver during pregnancy is more sensitive to agents that depress protein anabolism, such as the tetracyclines. The question is also raised as to whether or not pre-existing pyelonephritis may also be a predisposing factor in the production of liver of pregnancy. It is proposed that liver of pregnancy be referred to as fatty liver of pregnancy, idiopathic, or fatty liver of pregnancy, tetracycline associated.
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