Case of fulminant hepatic failure due to unrecognized peripartum cardiomyopathy.
OBJECTIVE
To describe a postpartum patient who presented with fulminant hepatic failure and hepatic coma as a result of unrecognized peripartum cardiomyopathy.


METHODS
Case report.


METHODS
Medical intensive care unit of a tertiary care academic medical center.


METHODS
A 35-yr-old woman 5 wks postpartum from an uneventful spontaneous vaginal delivery who was transferred to our institution with fulminant hepatic failure and worsening hepatic encephalopathy of unknown etiology for consideration of liver transplantation.


METHODS
An echocardiogram was obtained as part of an evaluation for refractory shock and the patient was found to have severe global hypokinesis with an ejection fraction of approximately 15%. She was diagnosed with peripartum cardiomyopathy and treatment with digoxin and afterload reduction was initiated.


RESULTS
After initiation of appropriate treatment for dilated cardiomyopathy, the patient's hepatic failure resolved and she made a full recovery.


CONCLUSIONS
Congestive heart failure is one of the few treatable causes of fulminant hepatic failure. Congestive heart failure must always be included in the differential diagnosis of fulminant hepatic failure of unknown pathogenesis.
Fussell
Kevin M
KM
Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA.
Awad
Joseph A
JA
Ware
Lorraine B
LB
D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001778:Blood Coagulation Disorders / Q000209:etiology / Q000628:therapy; D002216:Captopril / Q000627:therapeutic use; D009202:Cardiomyopathies / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy; D002316:Cardiotonic Agents / Q000627:therapeutic use; D003422:Critical Care / Q000379:methods; D003951:Diagnostic Errors; D004077:Digoxin / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006973:Hypertension / Q000209:etiology / Q000628:therapy; D007022:Hypotension / Q000209:etiology / Q000628:therapy; D017114:Liver Failure, Acute / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis* / Q000628:therapy; D006435:Renal Dialysis; D016896:Treatment Outcome
D000959:Antihypertensive Agents; D002316:Cardiotonic Agents; D004077:Digoxin; D002216:Captopril