Gestational Alloimmune Liver Disease and Congenital Athymia in a Neonate Born via In Vitro Fertilization Surrogacy

We report a rare case of gestational alloimmune liver disease (GALD) and congenital athymia in a 3-week-old premature male neonate, born via in vitro fertilization (IVF) surrogacy. The neonate initially presented with disseminated intravascular coagulation and septic shock, and subsequently developed liver failure. Despite aggressive treatment, he succumbed. Autopsy confirmed GALD, congenital athymia, splenomegaly, and extensive hemorrhage in the gastrointestinal mucosa and brain. Congenital athymia, characterized by a lack of functional T cells, might impair immune regulation or tolerance mechanisms and reduce the neonate's capacity to recover from GALD-induced liver injury. The additional context of an IVF surrogate pregnancy further complicates the immunologic landscape. This case highlights the need for further investigation into potential causal or synergistic relationships among these conditions to optimize management strategies for affected neonates.