Abstract

OBJECTIVE
Peripartum cardiomyopathy (PPCM) and acute fatty liver of pregnancy (AFLP) are rare complications of pregnancy affecting approximately 1/10,000 pregnancies each. We describe a patient who had biopsy-proven AFLP complicated by PPCM.
METHODS
Chart review and literature search.
RESULTS
The patient is a 22-year-old G5P1213 obese African-American female who presented at 30 weeks gestation with abdominal pain. She had normal blood pressures and mildly elevated liver enzymes. After completion of a 24 hour urine protein collection that was consistent with pre-eclampsia, an induction of labor with uncomplicated vaginal delivery was accomplished. Following delivery, a computed tomography scan of the abdomen revealed significant cardiomegaly. An echocardiogram revealed global dysfunction with an ejection fraction of 10%. Liver biopsy showed AFLP. Attempts to establish a unifying etiology were unrevealing. The PPCM was treated with diuretics and intravenous immunoglobulin. The patient's clinical status deteriorated, eventually requiring continuous dialysis, intubation, pharmacologic and mechanical inotropic support, and a feeding tube. The patient was discharged to a long-term care facility where she subsequently passed away from multiorgan failure.
CONCLUSION
AFLP and PPCM are rare complications of pregnancy. We present a patient who had both. Both diseases carry a high mortality rate, and together, are likely fatal.

Links

Publisher Full Text

Authors

Keyser EA, Reed BG, Gonzalez-Brown V, Fausett B, Staat BC, Leath CA

Institution

Department of OB/GYN, Wilford Hall Medical Center, 2200 Bergquist Drive, Suite 1, Lackland AFB, TX 78236-5570, USA.

Source

Military medicine 177:4 2012 Apr pg 470-3

MeSH

Adult
Body Mass Index
Cardiomyopathy, Dilated
Delivery, Obstetric
Diuretics
Drug Therapy, Combination
Fatal Outcome
Fatty Liver
Female
Humans
Immunoglobulins, Intravenous
Obesity
Peripartum Period
Pregnancy
Pregnancy Complications
Pregnancy Complications, Cardiovascular
Rare Diseases
Risk Factors

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

22594141