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Research and Reviews : A Journal of Medical Science and Technology Case Study

Concurrent Acute Fatty LIVER of Pregnancy, Acute Hepatitis, And Viral Meningitis in An Advanced Maternal Age Pregnancy a Rare Triple Presentation

  1. Kashish Parmar GMERS Civil Hospital, Valsad
  2. Aditya Parmar GMERS Civil Hospital, Valsad
  3. Zankruti Panchal GMERS Civil Hospital, Valsad
  4. Zaidan Kanunga , GMERS Civil Hospital, Valsad
  5. Vikas Parmar GMERS Civil Hospital, Valsad
  6. Sharad Ram GMERS Civil Hospital, Valsad

Abstract

Background: Acute fatty liver of pregnancy (AFLP) is a sometimes lethal, but very seldom, chronic hepatic disease during late pregnancy. The presence of AFLP with other severe diseases raises the level of diagnostic and therapeutic complexity to a higher level. Case Presentation: We present the case of a 45 years old multigravita and 26 weeks of gestation with a distinct triad of AFLP, acute viral hepatitis (cytomegalovirus [CMV] and herpes simplex virus [HSV]) and viral meningoencephalitis. The symptoms that were presented by the patient were fever, vomiting, jaundice, altered mental status, and progressive hepatic decompensation. The work carried out in the laboratory showed thrombocytopenia, coagulopathy, hyperbilirubinemia, and high transaminases. CMV and HSV TORCH serology were positive and the cerebrospinal fluid examination revealed pleocytosis. Abdominal ultrasound showed grade 3 fatty liver and neuroimaging showed subacute ischemic injury. Management and Outcome: Multidisciplinary team started management which was inclusive of hepatoprotective agents, antivirals, broad-spectrum antimicrobials, corticosteroids, and supportive therapy. The patient exhibited progressive liver dysfunction in spite of intense treatment.

Conclusion: What is unusual about this case is that it is a combination of AFLP, viral hepatitis, and viral meningoencephalitis in pregnancy, a combination never described to our knowledge in the literature. It reiterates the importance of high clinical suspicion, early diagnosis and multidisciplinary care in order to enhance the maternal and fetal outcomes in the case of this complicated clinical setting.

Keywords

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