title: Fulminant hepatitis A infection in second trimester of pregnancy requiring living-donor liver transplantation.
abstract: We present an 18-year-old pregnant woman who was referred to our emergency clinic as a case of acute hepatic failure and hepatic encephalopathy. Laboratory tests showed abnormal liver function tests and serological workup was consistent with acute hepatitis A infection. Ultrasonography revealed a single live fetus with fetal biometry compatible with 18 gestational weeks. The patient underwent a highly urgent liver transplantation using a right lobe graft from her husband. Histological examination of the explanted liver showed acute, lymphocyte-rich, diffuse necrotizing hepatitis, consistent with acute necrotizing hepatitis A. After the operation her allograft function gradually recovered. Her follow-up obstetrics ultrasound revealed a male fetus with severely decreased amniotic fluid. The patient was informed about the poor prognosis of her pregnancy and the pregnancy was terminated by vaginal misoprostol induction. She has maintained a good general condition and liver function for 4 months postoperatively, up to the present time.
authors.affiliation: Department of Obstetrics and Gynecology, Inonu University Faculty of Medicine, Malatya, Turkey. dryavuzsimsek@gmail.com
authors.forename: Yavuz
authors.initials: Y
authors.lastname: Simsek
authors.forename: Burak
authors.initials: B
authors.lastname: Isik
authors.forename: Abdullah
authors.initials: A
authors.lastname: Karaer
authors.forename: Onder
authors.initials: O
authors.lastname: Celik
authors.forename: Ramazan
authors.initials: R
authors.lastname: Kutlu
authors.forename: Nasuhi Engin
authors.initials: NE
authors.lastname: Aydin
authors.forename: Sezai
authors.initials: S
authors.lastname: Yilmaz
mesh_terms: D000293:Adolescent; D005260:Female; D006501:Hepatic Encephalopathy / Q000601:surgery*; D006506:Hepatitis A / Q000601:surgery*; D006801:Humans; D017114:Liver Failure, Acute / Q000601:surgery*; D016031:Liver Transplantation; D019520:Living Donors; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000601:surgery*; D011262:Pregnancy Trimester, Second