Acute Fatty Liver of Pregnancy: A Diagnostic Challenge

Acute fatty liver of pregnancy (AFLP) is a rare, catastrophic disease affecting women in the third trimester of pregnancy or the postpartum period. We report a case of 24-year-old G2A1 with GA of 35 weeks who presented with amenorrhea, nausea, fever, vomiting, headache and yellowness of eyes. The patient was diagnosed with severe preeclampsia with Intrauterine death (IUD) with hemolysis elevated liver enzymes low platelets (HELLP). Investigations showed hypoglycemia, low platelet count, and raised liver enzymes with an altered coagulation profile. The patient was kept in the Medicine Intensive care unit, induction was done with misoprostol, and she delivered an IUD baby. The condition of the patient deteriorated, and she developed pulmonary edema. Thus, she was intubated. Ultrasonography (USG) of the liver showed altered echotexture. The condition of the patient was then improved. AFLP requires a high index of suspicion for early diagnosis. Hypoglycemia in a pregnant woman without overt /gestational diabetes mellitus along with deranged liver panels and thrombocytopenia gives a clue in diagnosing AFLP. Timely diagnosis and intervention can reduce both maternal and fetal morbidity and mortality.