A case of DIC with acute hepatic failure developed in pregnancy.

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We present a case of acute hepatic failure which developed in the 2nd trimester of pregnancy, that was difficult to diagnose clinically and histologically.<BR>The patient was a 20-year-old female gravida II, in the 21st week of pregnancy. She had symptoms relating to a common cold followed by jaundice in the 23rd week. Upon admission, she had already suffered from DIC, acute hepatic failure as well as other multiple organ failure. After admission, her condition deteriorated and she expired in the 24th week of pregnancy. From the clinical course and findings, as acute fatty liver of pregnancy was suspected.<BR>Autopsy findings revealed multiple infarction with hemorrhage in the cut surface of the liver. Massive coagulative necroses of the hepatocytes with fibrin thrombi, suggesting circulatory disturbance, were observed histologically. Although the microvesicular fatty droplets, that are characteristic of acute fatty liver of pregnancy, were sparsely seen in the hepatocytes. Multiple coagulative necroses with fibrin thrombi were also seen in the glomeruli, both lungs, adrenal glands, and the bone marrow.<BR>In several previous papers, the possible relationship between Shwartzman phenomenon and acute hepatic failure with DIC was discussed. In this case we considered that the acute hapatic failure was caused by the Shwartzman phenomenon.
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