title: Pregnant woman with non-comatose autoimmune acute liver failure in the second trimester rescued using medical therapy: A case report.
abstract: We present the case of a 25-year-old woman at 16 weeks of gestation who presented with non-comatose autoimmune acute liver failure and was at high risk of developing fulminant hepatitis. Predictive formulas indicated a high probability of developing fulminant hepatitis. Unenhanced computed tomography showed marked hepatic atrophy and broadly heterogeneous hypoattenuating areas. The course of her illness was subacute, and the etiology of liver injury was unclear. Considering all of the above, we predicted a poor prognosis. Plasma exchange (PE) and continuous hemodiafiltration (CHDF) therapy were initiated just after admission. A few days after admission, a high titer (×80) of antinuclear antibody was noted. Because autoimmune hepatitis (AIH) was considered a cause of liver failure, treatment with moderate prednisolone (30 mg/day) doses was administrated, with careful consideration of her pregnancy. Thereafter, her laboratory findings and clinical course gradually improved without the need for liver transplantation. A liver biopsy at 18 days after admission indicated a diagnosis of AIH. She continued the pregnancy and delivered a healthy baby without any complications. Eventually, prednisolone doses were decreased to 10 mg, after which her liver function worsened. The second liver biopsy also indicated a diagnosis of AIH. Accordingly, low-dose prednisolone and azathioprine doses (50 mg/day) were administrated to recover her liver function, after which her liver function regained normalcy. This case illustrates that a pregnant woman with non-comatose autoimmune acute liver failure in the first or second trimester of pregnancy and her fetus can be rescued by PE/CHDF therapy and safe moderate doses of prednisolone.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Defense Medical College, Saitama, Japan.
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Sato
authors.forename: Kengo
authors.initials: K
authors.lastname: Tomita
authors.forename: Chihiro
authors.initials: C
authors.lastname: Yasue
authors.forename: Rumiko
authors.initials: R
authors.lastname: Umeda
authors.forename: Hirotoshi
authors.initials: H
authors.lastname: Ebinuma
authors.forename: Sho
authors.initials: S
authors.lastname: Ogata
authors.forename: Wenlin
authors.initials: W
authors.lastname: Du
authors.forename: Shigeyoshi
authors.initials: S
authors.lastname: Soga
authors.forename: Koji
authors.initials: K
authors.lastname: Maruta
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Yasutake
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Narimatsu
authors.forename: Shingo
authors.initials: S
authors.lastname: Usui
authors.forename: Chikako
authors.initials: C
authors.lastname: Watanabe
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Komoto
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Teratani
authors.forename: Takahiro
authors.initials: T
authors.lastname: Suzuki
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Yokoyama
authors.forename: Hidetsugu
authors.initials: H
authors.lastname: Saito
authors.forename: Shigeaki
authors.initials: S
authors.lastname: Nagao
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Hibi
authors.forename: Soichiro
authors.initials: S
authors.lastname: Miura
authors.forename: Takanori
authors.initials: T
authors.lastname: Kanai
authors.forename: Ryota
authors.initials: R
authors.lastname: Hokari
keywords: autoimmune hepatitis; continuous hemodiafiltration; non-comatose acute liver failure; plasma exchange; prednisolone; pregnancy