A case of chronic hepatitis B merged with acute fatty liver of pregnancy with severe coagulopathy

• Published in: JA clinical reports Vol. 5; no. 1; p. 1
• Main Authors: Fukushima, Risa, Kamata, Kotoe, Ariyoshi, Fumiko, Yanaki, Masashi, Nomura, Minoru, Ozaki, Makoto
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 07.01.2019; Springer Nature B.V; SpringerOpen
• Subjects: Acute fatty liver of pregnancy; Anesthesia; Anesthesiology; Antigens; Ascites; Biopsy; Blood pressure; Body temperature; Case Report; Cesarean section; Critical Care Medicine; Edema; Emergency Medicine; Fetuses; Hepatitis B; Hypoglycemia; Hypothermia; Intensive; Liver; Medical personnel; Medicine; Medicine & Public Health; Mortality; Pain Medicine; Parturient; Pregnancy; Uric acid; Viral infections; Acute fatty liver of pregnancy; Parturient; Hepatitis B; Hypothermia
• ISSN: 2363-9024; 2363-9024
• DOI: 10.1186/s40981-018-0219-5

Background Acute fatty liver of pregnancy (AFLP) is a life-threatening disorder, and its relevance to viral hepatitis B (HB) remains unknown. This case presents an initial experience of treating a patient with HB progressing to AFLP throughout pregnancy; anesthesiologists should also recognize its clinical feature for perioperative management. Case presentation A 28-year-old parturient was diagnosed as chronic HB (CHB) at 21 weeks gestation. Liver and kidney dysfunction appeared rapidly at 34 weeks gestation, suspected as acute exacerbation of either CHB or AFLP. Emergency cesarean section was carried out, after which maternal disseminated intravascular coagulation and hypothermia persisted. With multidisciplinary management, the patient and infant were discharged on postpartum days 64 and 12, respectively. Conclusions Active CHB develops into AFLP. Antiviral therapy should be considered for parturient patients with CHB, particularly for those with high viral load. The most favorable outcome is prompt and accurate diagnosis to establish suitable termination method.