Hepatic infarction associated with eclampsia

Pregnancy-related liver diseases are complex in presentation and oftentimes confusing to clinicians, leading to misdiagnoses and unwarranted or delayed therapies. The exact pathogenesis of these disorders and their relationship to pre-eclampsia/eclampsia is unclear, thus making categorization difficult. We present a patient who in the third trimester of pregnancy developed severe abdominal pain, fever and transaminases greater than 30 times normal. The patient's laboratory data, abdominal CT scan, abdominal MRI scan, liver-spleen scan and liver biopsy performed 28 days postpartum subsequently confirmed the diagnosis of hepatic infarction. Hepatic infarction is a rare complication of late pregnancy usually associated with severe eclampsia that has distinctive histologic and laboratory findings. Recognition of infarction as a separate entity among the spectrum of the pregnancy-related liver disorders should help avoid unneeded delay in diagnosis or inappropriate treatment of these critically ill patients.