Acute Fatty Liver of Pregnancy Presenting With Multiorgan Failure: A Case Report Highlighting Diagnostic Differentiation From Hemolysis, Elevated Liver Enzymes, and Low Platelets (HELLP) Syndrome and Implications for Early Intervention.

Acute fatty liver of pregnancy (AFLP) is a rare but potentially life-threatening complication of late gestation that often presents with nonspecific features and significant overlap with other obstetric conditions, posing a diagnostic challenge. We report a case of a 28-year-old multigravida at 34 weeks of gestation who presented with progressive jaundice, encephalopathy, and multiorgan dysfunction, including disseminated intravascular coagulation (DIC) and acute kidney injury (AKI) requiring renal replacement therapy. Laboratory evaluation revealed severe hypoglycemia, hyperammonemia, marked transaminase elevation, and profound coagulopathy, supporting the diagnosis of AFLP based on the Swansea criteria. The clinical picture was initially confounded by overlapping features with hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome; however, key biochemical markers facilitated diagnostic clarification. The patient underwent prompt multidisciplinary management, including metabolic stabilization, correction of coagulopathy, and emergency cesarean delivery, followed by intensive care support. Significant clinical and biochemical improvement was observed following delivery, with progressive recovery of hepatic and renal function. This case highlights the importance of early recognition, differentiation from mimicking conditions, and timely intervention in AFLP, particularly in severe presentations with multiorgan involvement. It further emphasizes the role of hypoglycemia and metabolic dysfunction as critical diagnostic indicators and supports the principle that prompt delivery remains the definitive treatment in preventing maternal morbidity and mortality.