Autoimmune Hepatitis in Pregnancy: Hematological Perturbation and Management Dilemma. A Case Report.

BACKGROUND: Autoimmune hepatitis (AIH) is a progressive chronic hepatitis of unknown cause that occurs in children and adults, with a paucity of informa- tion of this disorder existing -__ in pregnancy. CASE: A primigravid pa- tient presented at 30 weeks with altered mental status, abdominal pain, vomiting, and epistaxis. Her history was significant for por- tal hypertension, encepha- lopathy, ascites, coagulopathy, hyperammonemia, and end-stage liver disease secondary to AIH. Ultrasound revealed cirrhosis, ascites, splenomegaly, and an appro- priately grown singleton gestation. She received 2 intra- muscular doses of betamethasone over 24 hours, subcuta- neous vitamin K, and oral prednisone. A lower extremity venous Doppler study was negative for thrombosis. She received ceftriaxone 1 g daily x 5 days to treat sponta- neous bacterial peritonitis. A unit of packed red blood cells and 1 unit of platelets were transfused prior to a primary cesarean 2 weeks after the initial presentation. Postoperative agitation was managed with risperidone, and wound infection was treated with vancomycinl metronidazole. She discharged herself against medical advice on postoperative day 15, and the infant was dis- charged to foster care on day 15 of life. CONCLUSION: Multiple management challenges usu- ally arise in pregnancies com- plicated by end-stage - liver disease. However, with com- prehensive multidisciplin- ary care a successful perina- tal outcome can be accom- - plished.