Hindawi Publishing Corporation Case Reports in Obstetrics and Gynecology Volume 2011, Article ID 402710, 3 pages doi:10.1155/2011/402710 Case Report Mild Clinical Presentation of Acute Fatty Liver in the Second Trimester of Pregnancy Alaeddine Yassin,1 Walid Denguezli,1 Anissa Fessi,1 Leila Njim,2 Raja Falah,1 Abdelfattah Zakhama,2 and Mohamed Sakouhi1 1 Department of Obstetric and Gynecology, Fattouma Bourguiba Teaching Hospital, Avenue June 1, Monastir 5000, Tunisia 2 Department of Anatomy and Cytopathology, Fattouma Bourguiba Teaching Hospital, Avenue June 1, Monastir 5000, Tunisia Correspondence should be addressed to Walid Denguezli, walid.denguezli@gmail.com Received 7 May 2011; Accepted 27 June 2011 Academic Editor: E. Cosmi Copyright © 2011 Alaeddine Yassin et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. We report a case of 29 years old woman who was diagnosed with acute fatty liver of pregnancy at 23 weeks of gestation with unusual evolution (pregnancy prolonged until 36 weeks of gestation) to draw attention on the possibility of occurrence of this pathology in the second trimester of pregnancy even with a milder clinical presentation and course. 1. Introduction Acute fatty liver of pregnancy (AFLP) is an uncommon, life- threatening complication that occurs in the third trimester or early postpartum period [1]. In the literature, only few cases of acute fatty liver of pregnancy in the second trimester were reported [2, 3]. Here, we report a case of AFLP with a milder clinical presentation in the second trimester. 2. Case Report A 29-year-old woman, gravid 1, presented at 23 weeks’ gestation with nausea, vomiting, abdominal pain, malaise, and weight loss. An ultrasound at 11 weeks’ gestation deter- mined gestational age. She was normotensive with a normal platelet count and no proteinuria. She had elevated liver transaminase levels (aspartate aminotransferase [ASAT] level 108 U/L, alanine aminotransferase [ALAT] level 104 U/L), prothrombin time [PT] 96%, negative hepatitis serology (A, B, C, and E), and a negative immunologic analysis. She was treated with intravenous ﬂuids, but we remarked a slightly aggravation of her laboratory ﬁndings ASAT 122 U/L, ALAT 248 U/L, GGT 18 U/L, PAL 118 U/L, bilirubin total/direct 23,2/17,4 µmol/L, PT 76%, WBC 7800, platelets 178000, glucose 65 mg/dL, and uric acid 246 µmol/L. The abdominal ultrasound showed a brilliant liver without others anomalies. Because of the doubt on diagnosis and stable clinical and biologic parameters, a liver biopsy was performed (10 days after admission) and showed a microvesicular fatty inﬁltration of the hepatocytes (Figure 1). A diagnosis of acute fatty liver of pregnancy was conﬁrmed. The decision was to prolong the pregnancy under surveillance in obstetric unit care with clinical and biological control. The biological analyses were stable (Table 1) with good clinical condition. The evolution was good and the pregnancy was prolonged until 36 weeks of gestation, and the patient gave birth to a healthy newborn of 2900 g, Apgar score of 9/10. The delivery was simple without any complications. After delivery, all biologic parameters were normalized within 7–10 days and the patient was discharged. 3. Comments Acute fatty liver of pregnancy is a rare and potentially fatal condition. It has been thought that this condition is rare and usually takes a devastating course with signiﬁcant morbidity and mortality [1], incidence is estimated to be 1/1000 to 1/20000 deliveries [1], and, generally, it occurs in the third trimester or early postpartum period of pregnancy, but a few cases in the second trimester were published [2, 3].