title: Massive hepatic infarction in preeclampsia: successful treatment with continuous hemodiafiltration and corticosteroid therapy.
abstract: Massive hepatic infarction associated with pregnancy is extremely rare, but is potentially fatal. A 35-year-old primigravida with mild preeclampsia developed acute right upper quadrant pain and marked elevation of liver enzymes at 26 weeks' gestation. After emergent cesarean section, her condition was complicated by oliguric renal failure and pulmonary edema with further deterioration of hepatic function (aspartate transaminase 4339 IU/L; alanine transaminase 3489 IU/L; lactate dehydrogenase 10780 IU/L). The contrast-enhanced computed tomography revealed non-enhancing low attenuation throughout the right lobe of liver, compatible with infarction. Continuous hemodiafiltration was initiated as renal support on postpartum day one. However, excessive fluid accumulation persisted, and she developed severe edema formation in both lung and systemic body surface. To ameliorate microvascular endothelial injury, corticosteroid therapy was begun on postpartum day five. Following treatment initiation, her renal and hepatic function showed steady improvement, accompanied by drastic resolution of edema formation. She was discharged five weeks postpartum with no additional treatment, and is without sequelae six months later. Massive hepatic infarction should be considered in preeclamptic patients who present acute abdominal pain and severe hepatic dysfunction, and continuous hemodiafiltration with corticosteroid therapy may improve the maternal outcome.
authors.affiliation: Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Kei
authors.initials: K
authors.lastname: Miyakoshi
authors.forename: Mamoru
authors.initials: M
authors.lastname: Tanaka
authors.forename: Akiko
authors.initials: A
authors.lastname: Ono
authors.forename: Akiko
authors.initials: A
authors.lastname: Ohno
authors.forename: Ryohei
authors.initials: R
authors.lastname: Serita
authors.forename: Takeshi
authors.initials: T
authors.lastname: Suzuki
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Shinmoto
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Morisaki
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Yoshimura
mesh_terms: D015746:Abdominal Pain; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000328:Adult; D003937:Diagnosis, Differential; D005260:Female; D017583:Hemodiafiltration; D006801:Humans; D007238:Infarction / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy; D008099:Liver / Q000098:blood supply* / Q000000981:diagnostic imaging; D011225:Pre-Eclampsia / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D011247:Pregnancy; D014057:Tomography, X-Ray Computed
chemical_list: D000305:Adrenal Cortex Hormones