A 32-year-old primigravida at 36 weeks gestation presents with nausea, vomiting, jaundice, and hypoglycemia. Labs show ALT 480 U/L, bilirubin 6.2 mg/dL, INR 2.5, WBC 18,000/mm3, platelets 85,000/mm3, and uric acid 9.8 mg/dL. Ultrasound shows fatty infiltration of the liver. Which pathologic finding on liver biopsy is most characteristic of the suspected diagnosis?
- A Bridging necrosis and Councilman bodies
- B Periportal fibrosis with bile duct proliferation
- C Macrovesicular steatosis with Mallory-Denk bodies and neutrophilic infiltration
- D Microvesicular steatosis with central swollen hepatocytes and foamy cytoplasm ✓
Explanation
Acute fatty liver of pregnancy (AFLP) is a third-trimester emergency caused by fetal mitochondrial fatty acid oxidation defects (most commonly LCHAD deficiency in the fetus), leading to accumulation of microvesicular fat in maternal hepatocytes. Liver biopsy shows microvesicular steatosis with swollen hepatocytes and foamy cytoplasm, with relative sparing of the periportal zone. It requires urgent delivery. Macrovesicular steatosis with Mallory bodies suggests alcoholic hepatitis. Councilman bodies and bridging necrosis are seen in viral hepatitis. This condition has high maternal and fetal mortality if untreated.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.