Acute fatty liver of pregnancy and acetaminophen toxicity leading to liver failure and postpartum liver transplantation. A case report.
BACKGROUND
Acute fatty liver of pregnancy is a rare entity. A MEDLINE English-language search from 1966 to the present revealed no reports of acetaminophen toxicity and acute fatty liver in pregnancy.


METHODS
An 18-year-old, African American woman, gravida 1, presented at 33 weeks' gestation with signs and symptoms consistent with acute fatty liver of pregnancy and fetal death. Markedly elevated transaminases prompted a search for other etiologies, and acetaminophen toxicity was diagnosed. Liver biopsy revealed acute fatty liver of pregnancy and toxin-induced injury consistent with acetaminophen use. The patient's condition deteriorated, resulting in fulminant hepatic failure and requiring postpartum orthotopic liver transplantation.


CONCLUSIONS
The combination of acute fatty liver of pregnancy and acetaminophen toxicity resulted in acute liver failure. Attention to clinical and biochemical parameters can lead to diagnosis and management.
Gill
Edward J
EJ
Departments of Obstetrics and Gynecology and of Pathology, Medical College of Virginia, Virginia Commonwealth University, Richmond, USA. egill@hsc.vcu.edu
Contos
Melissa J
MJ
Peng
Thomas C C
TC
D000082:Acetaminophen / Q000009:adverse effects*; D000293:Adolescent; D018712:Analgesics, Non-Narcotic / Q000009:adverse effects*; D056486:Chemical and Drug Induced Liver Injury / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology / Q000628:therapy; D003937:Diagnosis, Differential; D005260:Female; D005313:Fetal Death / Q000175:diagnosis; D006801:Humans; D017093:Liver Failure / Q000139:chemically induced / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D016031:Liver Transplantation; D049590:Postpartum Period; D011247:Pregnancy; D011248:Pregnancy Complications / Q000139:chemically induced / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D011263:Pregnancy Trimester, Third
D018712:Analgesics, Non-Narcotic; D000082:Acetaminophen