Pregnant woman with non‐comatose autoimmune acute liver failure in the second trimester rescued using medical therapy: A case report |
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Authors: | 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 Hibi Soichiro Miura Takanori Kanai Ryota Hokari |
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Institution: | 1. Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Defense Medical College, Saitama, Japan;2. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan;3. Department of Pathology and Laboratory Medicine, National Defense Medical College, Saitama, Japan;4. Department of Pathology, Keio University School of Medicine, Tokyo, Japan;5. Department of Radiology, National Defense Medical College, Saitama, Japan;6. Health Center, Keio University School of Medicine, Tokyo, Japan;7. Graduate School of Pharmaceutical Sciences, Keio University Faculty of Pharmacy, Tokyo, Japan |
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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. |
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Keywords: | autoimmune hepatitis continuous hemodiafiltration non‐comatose acute liver failure plasma exchange prednisolone pregnancy |
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