Peripartum cardiomyopathy and acute fatty liver of pregnancy: one patient with two zebras

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. Chart review and literature search. The patient is a 22-year-old G5P...

Full description

Saved in:
Bibliographic Details
Published in:Military medicine 2012-04, Vol.177 (4), p.470-473
Main Authors: Keyser, Erin A, Reed, Beverly G, Gonzalez-Brown, Veronica, Fausett, Bardett, Staat, Barton C, Leath, Charles A
Format: Article
Language:English
Subjects:
Adult
Body Mass Index
Cardiomyopathy, Dilated - complications
Cardiomyopathy, Dilated - diagnosis
Cardiomyopathy, Dilated - drug therapy
Delivery, Obstetric
Diuretics - therapeutic use
Drug Therapy, Combination
Fatal Outcome
Fatty Liver - complications
Fatty Liver - diagnosis
Fatty Liver - drug therapy
Fatty Liver - etiology
Female
Humans
Immunoglobulins, Intravenous - therapeutic use
Obesity - complications
Peripartum Period
Pregnancy
Pregnancy Complications - diagnosis
Pregnancy Complications, Cardiovascular - diagnosis
Pregnancy Complications, Cardiovascular - drug therapy
Rare Diseases
Risk Factors
Citations: Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary: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. Chart review and literature search. 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. 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.
ISSN:0026-4075
1930-613X
DOI:10.7205/MILMED-D-11-00178