Diagnostic Challenges in Acute Fatty Liver of Pregnancy: Fever as a Key Symptom in Case Series from Indonesia
Abstract
Case series Patients: Female, 37-year-old • Female, 31-year-old • Female, 28-year-old Final Diagnosis: Acute fatty liver in pregnancy Symptoms: Fever • abdominal pain • nausea • vomiting • liver dysfunction indicators (elevated liver enzymes, hypoglycemia, and coagulopathy) Clinical Procedure: Cesarean section Specialty: Obstetrics and Gynecology Objective: Unusual clinical course Background: Acute fatty liver of pregnancy (AFLP) is a rare and catastrophic disease in pregnancy. It is important to distinguish between pathogenic diseases that cause abnormal liver function tests during pregnancy and typical physiological changes. An AFLP diagnosis can be established using Swansea criteria. AFLP typically occurs in the third trimester of pregnancy or postpartum, with a median presentation of 35–37 weeks of pregnancy. AFLP is also an obstetrical and medical emergency that is characterized by rapid deterioration of the patient’s condition. Case Reports: We present 3 cases from a tertiary hospital in Indonesia. The Swansea criteria were met in all 3 cases. Our cases were specifically characterized by complaints of fever. Fever complaints were not included in the Swansea criteria. The complaint of fever served to deceive and disorient the first treating clinician, resulting in a late referral. Delay of referral can lead to inappropriate treatment, prolonged duration of recovery, and the emergence of various complications, even death. In all of the cases reported here, the patients…
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