[A 33-year old pregnant woman with nausea, itching and fatigue]

Acute fatty liver of pregnancy (AFLP) is a serious, but rare condition with substantial maternal and perinatal mortality and morbidity. It occurs in the third trimester or early postpartum period. The medical history, physical examination and laboratory tests are often sufficient to make the diagnosis, and liver biopsy is rarely indicated. We present a 33-year-old woman with the diagnosis AFLP. Her case is presented to draw attention to AFLP as a differential diagnosis to liver diseases in pregnancy, especially the HELLP syndrome (haemolysis, elevated liver enzymes and low platelets). Appropriate diagnosis and prompt delivery is essential to optimal maternal and fetal outcome in both the AFLP and HELLP syndromes, and this should be followed by intensive care treatment of the dysfunctional maternal multiorgan system.