title: Peripartum cardiomyopathy and acute fatty liver of pregnancy: one patient with two zebras.
abstract: OBJECTIVE
  Peripartum cardiomyopathy (PPCM) and acute fatty liver of pregnancy (AFLP) are rare complications of pregnancy affecting approximately 1/10,000 pregnancies each. We describe a patient who had biopsy-proven AFLP complicated by PPCM.
  
  
  METHODS
  Chart review and literature search.
  
  
  RESULTS
  The patient is a 22-year-old G5P1213 obese African-American female who presented at 30 weeks gestation with abdominal pain. She had normal blood pressures and mildly elevated liver enzymes. After completion of a 24 hour urine protein collection that was consistent with pre-eclampsia, an induction of labor with uncomplicated vaginal delivery was accomplished. Following delivery, a computed tomography scan of the abdomen revealed significant cardiomegaly. An echocardiogram revealed global dysfunction with an ejection fraction of 10%. Liver biopsy showed AFLP. Attempts to establish a unifying etiology were unrevealing. The PPCM was treated with diuretics and intravenous immunoglobulin. The patient's clinical status deteriorated, eventually requiring continuous dialysis, intubation, pharmacologic and mechanical inotropic support, and a feeding tube. The patient was discharged to a long-term care facility where she subsequently passed away from multiorgan failure.
  
  
  CONCLUSIONS
  AFLP and PPCM are rare complications of pregnancy. We present a patient who had both. Both diseases carry a high mortality rate, and together, are likely fatal.
authors.affiliation: Department of OB/GYN, Wilford Hall Medical Center, 2200 Bergquist Drive, Suite 1, Lackland AFB, TX 78236-5570, USA.
authors.forename: Erin A
authors.initials: EA
authors.lastname: Keyser
authors.forename: Beverly G
authors.initials: BG
authors.lastname: Reed
authors.forename: Veronica
authors.initials: V
authors.lastname: Gonzalez-Brown
authors.forename: Bardett
authors.initials: B
authors.lastname: Fausett
authors.forename: Barton C
authors.initials: BC
authors.lastname: Staat
authors.forename: Charles A
authors.initials: CA
authors.lastname: Leath
mesh_terms: D000328:Adult; D015992:Body Mass Index; D002311:Cardiomyopathy, Dilated / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D036861:Delivery, Obstetric; D004232:Diuretics / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D017809:Fatal Outcome; D005234:Fatty Liver / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D009765:Obesity / Q000150:complications; D058725:Peripartum Period; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis* / Q000188:drug therapy; D035583:Rare Diseases; D012307:Risk Factors
chemical_list: D004232:Diuretics; D016756:Immunoglobulins, Intravenous