Acute fatty liver of pregnancy with transient resolution preceding postpartum liver failure requiring liver transplant

Objectives: Acute fatty liver of pregnancy (AFLP) is a rare, potentially fatal complication of unknown etiology that occurs in the third trimester or early postpartum and can be associated with adverse maternal and fetal outcomes. The purpose of this report is to share a case of AFLP in which a period of objective and symptomatic resolution preceded delayed postpartum liver failure and liver transplant. Case presentation: A 35-year-old G3P0020 female experienced preterm premature rupture of membranes (PPROM) at 32 weeks' gestation and AFLP. She delivered vaginally and despite apparent initial disease resolution, was found 22 days later to have fulminant acute liver failure that required liver transplantation. Conclusions: AFLP should be monitored closely postpartum even if disease parameters initially appear to resolve after delivery.