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Fulminant liver failure IN PREGNANCY

Hannah B Anastasio, Maureen Grundy, Meredith L Birsner, Karin J Blakemore
BACKGROUND: Gestational alloimmune liver disease, a form of profound liver failure in the newborn, is the main underlying cause of the entity formerly known as neonatal hemochromatosis. Antepartum maternal intravenous immunoglobulin (IVIG) has been shown to prevent gestational alloimmune liver disease, which otherwise has a recurrence risk above 90% in subsequent pregnancies. CASE: A 30-year-old woman, gravida 3 para 0120, presented early in gestation. Her previous pregnancy had been complicated by fetal growth restriction, oligohydramnios, and ultimately fatal fulminant neonatal liver failure...
October 6, 2016: Obstetrics and Gynecology
Tabassum Firoz, Douglas Webber, Hilary Rowe
Liver disease in pregnancy can be classified as predating, co-incidental or unique to pregnancy. Medications are often overlooked as a significant cause of liver disease. We present the case of a 39-year-old patient who presented at 20 weeks with jaundice, elevated liver enzymes, and abnormal liver function progressing eventually to fulminant hepatic failure. The patient was on methyldopa and labetalol from 12 weeks' gestational age. Liver biopsy was consistent with drug-induced liver injury. Both methyldopa and labetalol have been associated with hepatotoxicity including liver failure...
December 2015: Obstetric Medicine
Malika Sharma, Shital Gandhi
Hepatitis B surface antigen (HBsAg) positivity presents unique management challenges in pregnancy. We present the case of a 26-year-old HBsAg-positive woman who presented at 35 weeks gestational age with nausea, vomiting, and abdominal pain with markedly elevated liver enzymes. An elevated alpha feto-protein on antenatal screening had been misconstrued as fetal in origin. Magnetic resonance imaging and liver biopsy confirmed hepatocellular carcinoma. She died of fulminant hepatic failure two weeks after emergent delivery...
December 2014: Obstetric Medicine
Naomi E Clarke, Damien Gilby, Helen Savoia, Mark R Oliver, Sheryle Rogerson
Neonatal acute liver disease is relatively rare, with multiple different aetiologies including congenital infections, metabolic disorders, gestational alloimmune liver disease, haemophagocytic lymphohistiocytosis, and ischaemic injury. We report a case of neonatal liver failure in a preterm, growth-restricted infant, who underwent extensive investigation and was clinically diagnosed with gestational alloimmune liver disease, which was confirmed on post-mortem examination. We then discuss management of neonatal liver failure and gestational alloimmune liver disease, including maternal management in future pregnancies...
March 2016: Journal of Paediatrics and Child Health
Marcial Sebode, Christoph Schramm
BACKGROUND: Oftentimes we are expected to make difficult decision when patients with autoimmune hepatitis (AIH) present themselves before us. Among these cases, advanced liver cirrhosis, fulminant AIH with hepatic failure or pregnancy with highly active AIH will pose challenges on their own. In patients where standard treatment has failed, the risk of disease progression including liver transplantation has to be weighed against the risk of drug-related side effects, including infectious complications...
2015: Digestive Diseases
Alvaro Sepulveda-Martinez, Carlos Romero, Guido Juarez, Jorge Hasbun, Mauro Parra-Cordero
Abnormalities in liver function tests appear in 3% of pregnancies. Severe acute liver damage can be an exclusive condition of pregnancy (dependent or independent of pre-eclampsia) or a concomitant disease. HELLP syndrome and acute fatty liver of pregnancy are the most severe liver diseases associated with pregnancy. Both appear during the third trimester and have a similar clinical presentation. Acute fatty liver may be associated with hypoglycemia and HELLP syndrome is closely linked with pre-eclampsia. Among concomitant conditions, fulminant acute hepatitis caused by medications or virus is the most severe disease...
May 2015: Revista Médica de Chile
Jeffrey J Cies, Wayne S Moore, Kyle Miller, Christine Small, Dominick Carella, Susan Conley, Jason Parker, Paul Shea, Arun Chopra
Disseminated herpes simplex virus (HSV) infection in neonates represents a devastating entity that yields high mortality. Acyclovir is the primary antiviral agent used to treat life-threatening HSV infections in neonates; however, even though the agent has reduced morbidity overall from these infections, mortality with disseminated disease remains high. Currently, to our knowledge, no data exist regarding therapeutic drug monitoring of acyclovir in the setting of extracorporeal life support (ECLS) or continuous renal replacement therapy (CRRT) coupled with ECLS...
February 2015: Pharmacotherapy
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
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...
March 2015: Hepatology Research: the Official Journal of the Japan Society of Hepatology
Zahida Parveen Brohi, Aneela Sadaf, Uzma Perveen
OBJECTIVE: To determine the etiology, clinical features and outcome of fulminant hepatic failure in pregnancy. METHODS: An observational hospital based study was conducted at Isra University hospital Hyderabad from 1st March 2009 to 28th February 2010. Total 1192 obstetric patients were admitted in obstetrics & gynaecology department during this period, of whom 52 were with Fulminant hepatic failure in pregnancy and were included in this study. A pre-designed structured proforma was used...
September 2013: JPMA. the Journal of the Pakistan Medical Association
Manuel Mendizabal, Carlos Rowe, Federico Piñero, Ariel Gonzalez-Campaña, Martín Fauda, Diego Tomás Arufe, María Pía Raffa, Mariano Barreiro, Rodolfo Keller, Fernando Cacheiro, Ernesto Beruti, Oscar Andriani, Marcelo Oscar Silva, Luis Gustavo Podestá
Severe liver dysfunction during pregnancy implies a serious risk for both mother and fetus, and represents a technical and ethical challenge for treating physicians. We report a case of a previously healthy 32-year old woman who was admitted to our hospital with idiopathic fulminant hepatic failure and underwent successful orthotopic liver transplantation (OLT) at gestation week 21. Patient's and fetus' immediate postoperative course were relatively uneventful until week six after OLT, when the mother developed oligohydramnios and preeclampsia...
March 2014: Annals of Hepatology
Yin-Chu Chien, Chyi-Feng Jan, Chun-Ju Chiang, Hsu-Sung Kuo, San-Lin You, Chien-Jen Chen
UNLABELLED: Hepatitis B immunization has been documented to prevent fulminant hepatic failure (FHF) and hepatocellular carcinoma (HCC) by historical comparison studies in Taiwan. This study aimed to assess long-term risks and predictors of various liver diseases associated with incomplete immunization in 3.8 million vaccinees. Profiles of the National Hepatitis B Immunization Registry, National Cancer Registry, and National Death Certification Registry were linked to ascertain newly diagnosed cases of HCC and deaths from FHF and chronic liver diseases (CLDs) from infancy to early adulthood of 3,836,988 newborn vaccinees...
July 2014: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
Rashida Sultana, Shamsa Humayun
OBJECTIVE: To determine fetomaternal outcome in pregnant women with acute hepatitis E in terms of pregnancy outcome and perinatal mortality. STUDY DESIGN: Case series. PLACE AND DURATION OF STUDY: Department of Obstetrics and Gynecology, Sir Ganga Ram Hospital, Lahore, from July 2012 to March 2013. METHODOLOGY: Serum samples of 38 patients who presented with jaundice in pregnancy were collected to detect hepatitis E IgM antibodies...
February 2014: Journal of the College of Physicians and Surgeons—Pakistan: JCPSP
Ashok Kumar, Salam Gyaneshwori Devi, Premashis Kar, Sarita Agarwal, Syed Akhtar Husain, Ram Kumar Gupta, Shashi Sharma
AIMS: The aim of this study was to evaluate tumour necrosis factor-alpha (TNF-α), interleukin (IL)-6, interferon gamma (IFN-γ) and transforming growth factor-beta1 (TGF-β1) in hepatitis E infection during pregnancy and its relation with pregnancy outcome. METHODS: A total of 272 pregnant and 219 non-pregnant women with hepatitis and 262 age and gestational age matched healthy pregnant women and 208 age matched, healthy non-pregnant women were evaluated on the basis of history, clinical examination, liver function profile...
January 2014: Cytokine
A Bal, C Zandotti, A Nougairede, L Ninove, B Roquelaure, R N Charrel
We describe a case of a severe neonatal infection by herpes simplex virus (HSV) type 1 acquired postnatally from his father. The delivery and the first days of life were normal. He developed liver failure and disseminated intravascular coagulation when he was 19 days old. He was treated with intravenous acyclovir and the outcome was favorable. This case underlines that prevention of post-natal transmission of HSV merits to be considered in educational pregnancy programs directed at mothers and fathers.
2013: Open Virology Journal
Zaigham Abbas, Rafia Afzal
HEV generally causes a self-limited acute infection and treatment remains supportive. However, severe hepatitis or fulminant hepatic failure may occur, more so during pregnancy. It is an important cause of acute-on-chronic liver failure in endemic areas. Chronic HEV infection and progressive disease has been reported in recipients of solid organ transplants, haematological malignancies, HIV patients and those on haemodialysis. Clearance of HEV may occur after reducing immunosuppressive therapy, especially those targeting T-cells, in about one third of cases...
2014: Antiviral Therapy
Saumya Jayakumar, Raiyan Chowdhury, Carrie Ye, Constantine J Karvellas
Acute liver failure (ALF) is a condition wherein the previously healthy liver rapidly deteriorates, resulting in jaundice, encephalopathy, and coagulopathy. There are approximately 2000 cases per year of ALF in the United States. Viral causes (fulminant viral hepatitis [FVH]) are the predominant cause of ALF in developing countries. Given the ease of spread of viral hepatitis and the high morbidity and mortality associated with ALF, a systematic approach to the diagnosis and treatment of FVH is required. In this review, the authors describe the viral causes of ALF and review the intensive care unit management of patients with FVH...
July 2013: Critical Care Clinics
K R Franko, K L Mekeel, D Woelkers, A Khanna, A W Hemming
Acetaminophen overdose is the most rapidly growing cause of fulminant hepatic failure in Western countries. Pregnant women are counseled that acetaminophen is safe during pregnancy and an alternative to nonsteroidal anti-inflammatory medications. This report describes a case of acetaminophen overdose during the second trimester of pregnancy with resultant fulminant hepatic failure requiring liver transplantation. The fetus was previable at the time of liver transplantation, and methods to preserve viability during and after transplantation are discussed...
June 2013: Transplantation Proceedings
Milan Patel, Ram Subramanian
SESSION TYPE: Critical Care Student/Resident Case Report Posters IIPRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PMINTRODUCTION: Liver transplantation (LT) for acute liver failure (ALF) is an uncommon occurrence in the setting of pregnancy, and carries a high risk of fetal demise in the first and second trimesters. Furthermore, maternal hyperthyroidism increases fetal risk in the setting of LT, and the medical literature contains a single case report in this context that reported fetal demise (1)...
October 1, 2012: Chest
Shinju Arata, Akito Nozaki, Kenichi Takizawa, Masaaki Kondo, Manabu Morimoto, Kazushi Numata, Sanae Hayashi, Tsunamasa Watanabe, Yasuhito Tanaka, Katsuaki Tanaka
A 23-year-old nulliparous woman, a hepatitis B virus (HBV) carrier with stable liver functions, presented with exacerbation of viral replication (HBV DNA level >9.0 log copies/mL) in gestational week 26. During the subsequent follow up without antiviral therapy, she was hospitalized with progression to hepatic failure in gestational week 35. Following initiation of antiviral therapy with lamivudine, emergent cesarean delivery was conducted for fetal safety. Liver atrophy and persistent hepatic encephalopathy (stage 2) necessitated artificial liver support (ALS) involving online hemodiafiltration (HDF) and plasma exchange...
February 7, 2013: Hepatology Research: the Official Journal of the Japan Society of Hepatology
Heiner Wedemeyer, Jolanta Rybczynska, Sven Pischke, Kris Krawczynski
The course of hepatitis E virus infection (HEV) can vary substantially between different individuals. Although most infections take a clinically silent asymptomatic course, a few patients may develop severe hepatitis that can progress to fulminant hepatic failure. In addition, cases of chronic hepatitis E have been described in immunosuppressed patients. The detailed mechanisms leading to different clinical outcomes of HEV infection are only partially understood. Both viral factors including the HEV genotype and the dose of the infectious inoculum, as well as host factors such as stage of liver disease, pregnancy or distinct genetic polymorphisms determine the course of HEV infection...
February 2013: Seminars in Liver Disease
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