P2970 - Hepatic Infarction in a Healthy Young Female With Recent Vaginal Delivery

Yasir Ali, MD, Alana Persaud, MD, Elliot Bigajer, DO
Brookdale University Hospital, Brooklyn, NY

Introduction: Hepatic infarction (HI) is a catastrophic condition with a high mortality rate which requires urgent intervention. We present a rare case of acute liver failure (ALF) as a relatively late complication of postpartum cardiomyopathy (PPCM) in a young primiparous female with no pre-existing risk factors. Liver function subsequently responded to mechanical cardiac support with left ventricular assist device (LVAD).

Case Description/Methods: A 21 year-old female with a history of uneventful vaginal delivery three months prior presented with severe fatigue, dizziness and weight loss of 30 lbs. She denied tylenol/substance use, history of viral hepatitis or hypotensive episodes. Exam was remarkable for a young lethargic female with BP of 93/59 mmHg, HR 120 beats/min, scleral icterus, abdominal distension and mild RUQ tenderness. Labs include ALT >2250 U/L, AST >1500 U/L, bilirubin 6.5 mg/dl, PT 44, INR 3.54 and platelet 76 10x3/uL. Serologies for viral hepatitis, autoimmune workup, acetaminophen level, urine toxicology and troponin were negative. CT imaging revealed diffusely heterogeneous hepatic parenchyma with areas of low density indicating infarctions (Fig. 1). Echo showed an EF of 10% with diffuse hypokinesis and dilation. Given these findings, the patient was then transferred to an advanced center for management of ALF and cardiogenic shock. After inotropes and intra-aortic balloon pump, LVAD was subsequently placed, leading to significant improvement in liver function. Myocardial biopsy demonstrated hypertrophy with fibrosis consistent with PPCM. Labs prior to discharge revealed improvement: AST 19, ALT 21, PT 22.5, INR 2.1, bilirubin 0.7 and platelets 565. Repeat echo showed EF of 25%. Patient improved clinically and was discharged on heart failure therapy, warfarin and extensive counseling on avoiding future pregnancy.

Discussion: HI may result from hemodynamic instability with rise in transaminase levels to the 1000’s IU/L, severe coagulopathy, encephalopathy, and jaundice. Preexisting congestive heart failure and cirrhosis are often present. Severity correlates with both duration and extent of the hemodynamic compromise and the development of jaundice. Factors determining high mortality include renal failure, coagulopathy, need for vasopressors, severe encephalopathy and hyperphosphatemia. Our patient had no risk factors, presented with ALF and was diagnosed with HI on CT with low attenuation lesions of variable shape and location.



Disclosures:


Yasir Ali, MD, Alana Persaud, MD, Elliot Bigajer, DO. P2970 - Hepatic Infarction in a Healthy Young Female With Recent Vaginal Delivery, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.