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Pregnant woman with non‐comatose autoimmune acute liver failure in the second trimester rescued using medical therapy: A case report
Author(s) -
Sato Hirokazu,
Tomita Kengo,
Yasue Chihiro,
Umeda Rumiko,
Ebinuma Hirotoshi,
Ogata Sho,
Du Wenlin,
Soga Shigeyoshi,
Maruta Koji,
Yasutake Yuichi,
Narimatsu Kazuyuki,
Usui Shingo,
Watanabe Chikako,
Komoto Shunsuke,
Teratani Toshiaki,
Suzuki Takahiro,
Yokoyama Hirokazu,
Saito Hidetsugu,
Nagao Shigeaki,
Hibi Toshifumi,
Miura Soichiro,
Kanai Takanori,
Hokari Ryota
Publication year - 2015
Publication title -
hepatology research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.123
H-Index - 75
eISSN - 1872-034X
pISSN - 1386-6346
DOI - 10.1111/hepr.12344
Subject(s) - medicine , prednisolone , autoimmune hepatitis , azathioprine , liver transplantation , liver function tests , pregnancy , liver biopsy , fulminant hepatic failure , hepatitis , acute fatty liver of pregnancy , liver function , immunosuppression , fulminant hepatitis , gastroenterology , gestation , surgery , transplantation , biopsy , disease , biology , genetics
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.