Acute fatty liver of pregnancy and intrauterine fetal demise-case report and a literature review.

We present the case of a 43-year-old multiparous pregnant patient at 29 weeks of gestation admitted to the emergency department with altered consciousness (minimally conscious state), vomiting, and pain in the upper part of the abdomen. Ultrasound examination on admission revealed intrauterine fetal demise of a male fetus. Considering the general condition and intrauterine fetal demise, cesarean section was performed. Postoperatively, the condition of the patient required admission to the intensive care unit (ICU). Treatment included corticosteroid therapy, ursodeoxycholic acid, and correction of a coagulation disorder. Disseminated intravascular coagulopathy was excluded based on laboratory findings, which revealed liver insufficiency with impaired synthetic and excretory function as well as acute kidney injury. Screenings for hepatotropic viruses (hepatitis A, B, C; cytomegalovirus, Epstein-Barr virus, herpes simplex virus types 1 and 2) as well as autoimmune and metabolic liver diseases were negative. Computed tomography (CT) of the abdomen was performed, indicating acute fatty liver of pregnancy (AFLP). The diagnosis was confirmed by ultrasound-guided percutaneous liver biopsy and histopathological analysis. During further treatment, synthetic and excretory liver function recovery was achieved, along with complete improvement of renal function parameters. The patient was discharged to home care in with a satisfactory general condition and laboratory findings.