Concurrent Acute Fatty LIVER of Pregnancy, Acute Hepatitis, And Viral Meningitis in An Advanced Maternal Age Pregnancy a Rare Triple Presentation

Year : 2026 | Volume : 15 | Issue : 01 | Page : 7 11
    By

    Kashish Parmar,

  • Aditya Parmar,

  • Zankruti Panchal,

  • Zaidan Kanunga,

  • Vikas Parmar,

  • Sharad Ram,

  1. Intern Doctor, GMERS Civil Hospital, Valsad, Gujarat, India
  2. Intern Doctor, GMERS Civil Hospital, Valsad, Gujarat, India
  3. Intern Doctor, GMERS Civil Hospital, Valsad, Gujarat, India
  4. Intern Doctor, , GMERS Civil Hospital, Valsad, Gujarat, India
  5. Intern Doctor, GMERS Civil Hospital, Valsad, Gujarat, India
  6. Intern Doctor, GMERS Civil Hospital, Valsad, Gujarat, India

Abstract

Background: Acute fatty liver of pregnancy (AFLP) is a sometimes lethal, but very seldom, chronic hepatic disease during late pregnancy. The presence of AFLP with other severe diseases raises the level of diagnostic and therapeutic complexity to a higher level. Case Presentation: We present the case of a 45 years old multigravita and 26 weeks of gestation with a distinct triad of AFLP, acute viral hepatitis (cytomegalovirus [CMV] and herpes simplex virus [HSV]) and viral meningoencephalitis. The symptoms that were presented by the patient were fever, vomiting, jaundice, altered mental status, and progressive hepatic decompensation. The work carried out in the laboratory showed thrombocytopenia, coagulopathy, hyperbilirubinemia, and high transaminases. CMV and HSV TORCH serology were positive and the cerebrospinal fluid examination revealed pleocytosis. Abdominal ultrasound showed grade 3 fatty liver and neuroimaging showed subacute ischemic injury. Management and Outcome: Multidisciplinary team started management which was inclusive of hepatoprotective agents, antivirals, broad-spectrum antimicrobials, corticosteroids, and supportive therapy. The patient exhibited progressive liver dysfunction in spite of intense treatment. Conclusion: What is unusual about this case is that it is a combination of AFLP, viral hepatitis, and viral meningoencephalitis in pregnancy, a combination never described to our knowledge in the literature. It reiterates the importance of high clinical suspicion, early diagnosis and multidisciplinary care in order to enhance the maternal and fetal outcomes in the case of this complicated clinical setting.

Keywords: Acute fatty liver of pregnancy, acute viral hepatitis, AFLP, cytomegalovirus infection, herpes simplex virus, pregnancy-related liver disease

[This article belongs to Research and Reviews : A Journal of Medical Science and Technology ]

How to cite this article:
Kashish Parmar, Aditya Parmar, Zankruti Panchal, Zaidan Kanunga, Vikas Parmar, Sharad Ram. Concurrent Acute Fatty LIVER of Pregnancy, Acute Hepatitis, And Viral Meningitis in An Advanced Maternal Age Pregnancy a Rare Triple Presentation. Research and Reviews : A Journal of Medical Science and Technology. 2026; 15(01):7-11.
How to cite this URL:
Kashish Parmar, Aditya Parmar, Zankruti Panchal, Zaidan Kanunga, Vikas Parmar, Sharad Ram. Concurrent Acute Fatty LIVER of Pregnancy, Acute Hepatitis, And Viral Meningitis in An Advanced Maternal Age Pregnancy a Rare Triple Presentation. Research and Reviews : A Journal of Medical Science and Technology. 2026; 15(01):7-11. Available from: https://journals.stmjournals.com/rrjomst/article=2026/view=238922


References

  1. Ramanathan R, Ibdah JA. Mitochondrial dysfunction and acute fatty liver of pregnancy. Int J Mol Sci. 2022;23(7):3595. doi:10.3390/ijms23073595.
  2. Naoum EE, Leffert LR, Chitilian HV, Gray KJ, Bateman BT. Acute fatty liver of pregnancy: pathophysiology, anesthetic implications, and obstetrical management. Anesthesiology. 2019;130(3):446–461. doi:10.1097/ALN.0000000000002597.
  3. Bourque L, Mahone M. Acute fatty liver in pregnancy presenting in the second trimester: a systematic literature review. Obstet Med. 2025;1753495X251338746. doi:10.1177/1753495X251338746.
  4. Ibdah JA. Acute fatty liver of pregnancy: an update on pathogenesis and clinical implications. World J Gastroenterol. 2006;12(46):7397-7404. doi:10.3748/wjg.v12.i46.7397.
  5. Griffin KM, Oxford-Horrey C, Bourjeily G. Obstetric disorders and critical illness. Clin Chest Med. 2022;43(3):471–488. doi:10.1016/j.ccm.2022.04.008.
  6. Natarajan SK, Thangaraj KR, Goel A, Eapen CE, Balasubramanian KA, Ramachandran A. Acute fatty liver of pregnancy: an update on mechanisms. Obstet Med. 2011;4(3):99–103. doi:10.1258/om.2011.100071.
  7. Ko H, Yoshida EM. Acute fatty liver of pregnancy. Can J Gastroenterol. 2006;20(1):25–30. doi:10.1155/2006/638131.
  8. Tan J, Hou F, Xiong H, Pu L, Xiang P, Li C. Swansea criteria score in acute fatty liver of pregnancy. Chin Med J (Engl). 2022;135(7):860–862. doi:10.1097/CM9.0000000000001821.
  9. Goel A, Jamwal KD, Ramachandran A, Balasubramanian KA, Eapen CE. Pregnancy-related liver disorders. J Clin Exp Hepatol. 2014;4(2):151–162. doi:10.1016/j.jceh.2013.03.220.
  10. Morton A, Phillips L, Nisbet J, He JW. The risk of recurrence of acute fatty liver of pregnancy: a review of the current literature. Obstet Med. 2025;1753495X251317259. doi:10.1177/1753495X251317259.
  11. Gorginzadeh M, Safari S, Alavian SM. Acute fatty liver of pregnancy: a life-threatening condition requiring a life-saving approach. Hepat Mon. 2016;16(6):e35256. doi:10.5812/hepatmon.35256.
  12. Korula J, Malatjalian DA, Badley BW. Acute fatty liver of pregnancy. Can Med Assoc J. 1982;127(7):575–578.
  13. Minakami H, Morikawa M, Yamada T, Akaishi R, Nishida R. Differentiation of acute fatty liver of pregnancy from the syndrome of hemolysis, elevated liver enzymes and low platelet counts: AFLP and HELLP syndrome. J Obstet Gynaecol Res. 2014;40(3):641–649. doi:10.1111/jog.12282.
  14. Kushner T, Tholey D, Dodge J, Saberi B, Schiano T, Terrault N. Outcomes of liver transplantation for acute fatty liver disease of pregnancy. Am J Transplant. 2019;19(7):2101–2107. doi:10.1111/ajt.15401.
  15. Zhong Y, Zhu F, Ding Y. Early diagnostic test for acute fatty liver of pregnancy: a retrospective case-control study. BMC Pregnancy Childbirth. 2020;20(1):162. doi:10.1186/s12884-020-2787-4.
  16. Li Z, Zhang Z, Yu J, Du X, Lei P, Ruan Z, et al. Imaging of pregnancy-related liver diseases. iLIVER. 2023;2(1):56–66. doi:10.1016/j.iliver.2023.02.003.
Regular Issue Subscription Case Study
Volume 15
Issue 01
Received 07/01/2026
Accepted 31/01/2026
Published 10/03/2026
Publication Time 62 Days
29

Login


My IP

PlumX Metrics