Pregnant woman with non-comatose autoimmune acute liver failure in the second trimester rescued using medical therapy: A case report

Hirokazu Sato, Kengo Tomita, Chihiro Yasue, Rumiko Umeda, Hirotoshi Ebinuma, Sho Ogata, Wenlin Du, Shigeyoshi Soga, Koji Maruta, Yuichi Yasutake, Kazuyuki Narimatsu, Shingo Usui, Chikako Watanabe, Shunsuke Komoto, Toshiaki Teratani, Takahiro Suzuki, Hirokazu Yokoyama, Hidetsugu Saito, Shigeaki Nagao, Toshifumi HibiSoichiro Miura, Takanori Kanai, Ryota Hokari

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3 Citations (Scopus)

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 (30mg/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 10mg, after which her liver function worsened. The second liver biopsy also indicated a diagnosis of AIH. Accordingly, low-dose prednisolone and azathioprine doses (50mg/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.

Original languageEnglish
Pages (from-to)349-355
Number of pages7
JournalHepatology Research
Volume45
Issue number3
DOIs
Publication statusPublished - 2015 Mar 1

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Keywords

  • Autoimmune hepatitis
  • Continuous hemodiafiltration
  • Non-comatose acute liver failure
  • Plasma exchange
  • Prednisolone
  • Pregnancy

ASJC Scopus subject areas

  • Hepatology
  • Infectious Diseases

Cite this

Sato, H., Tomita, K., Yasue, C., Umeda, R., Ebinuma, H., Ogata, S., Du, W., Soga, S., Maruta, K., Yasutake, Y., Narimatsu, K., Usui, S., Watanabe, C., Komoto, S., Teratani, T., Suzuki, T., Yokoyama, H., Saito, H., Nagao, S., ... Hokari, R. (2015). Pregnant woman with non-comatose autoimmune acute liver failure in the second trimester rescued using medical therapy: A case report. Hepatology Research, 45(3), 349-355. https://doi.org/10.1111/hepr.12344