Acute Fatty Liver of Pregnancy

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Abstract
This report describes the thirteenth patient who has recovered from acute fatty liver of pregnancy and describes the clinical features, laboratory results and light and electron microscopic studies of serial liver biopsies. Although the administration of tetracycline compounds have been implicated in the pathogenesis of this disorder, severe nutritional deprivation is presumed to have been the prime predisposing factor in this patient. The results of liver function studies in this disease reveal a profile characteristic of acute hepatic failure without cellular necrosis or inflammation. Light microscopic studies of liver biopsy material demonstrate both the initial unusual characterisitc histology and the regenerative changes associated with clinical recovery. Electron micrographs reveal a striking honeycomb appearance of the smooth endoplasmic reticulin compatible with selective cellular damage due either to nutritional deficiency or to a toxic agent. The management of this patient is described including the rationale for the use of citrovorum factor. The similarity of this lesion to that associated with tetracycline administration in pregnancy was noted, and the hazard attendent to the use of these drugs in nutritionally depleted pregnant women is emphasized.