A Rare Disease Presenting Postpartum: Acute Fatty Liver of Pregnancy.

Acute fatty liver of pregnancy is a rare but highly fatal disease affecting women most frequently during the third trimester of pregnancy or in the postpartum period. It is considered a diagnosis of exclusion and requires a timely diagnosis to avoid maternal mortality. We present the case of a 33-year-old primigravida who required an emergency cesarean section due to fetal bradycardia. On postoperative day one, the patient was noted jaundiced, oliguric, and hypoglycemic. Laboratory tests revealed important hepatic dysfunction, coagulopathy, and renal failure. She was admitted to the Intensive Care Unit with the suspicion of acute fatty liver of pregnancy. Plasma exchange was started on postoperative day 5 with major clinical and laboratory improvement. A transjugular hepatic biopsy confirmed the diagnosis. The patient had satisfactory evolution and was discharged 15 days after delivery. Acute fatty liver of pregnancy is a highly morbid disease that needs a high index of suspicion to be diagnosed. Admission to an Intensive Care Unit to ensure maximum supportive care is mandatory in this disease.

Aneurisma de Arteria Pulmonar como causa de muerte repentina: Reporte de un caso y revisión de literatura / Pulmonary Artery Aneurysm as a cause of sudden death: Case report and literature review

Resumen Objetivo: Correlacionar las generalidades de la etiología, patogenia, presentación clínica y métodos diagnósticos actuales disponibles para el aneurisma de arteria pulmonar con la muerte súbita o repentina de estos pacientes. Materiales y métodos: Se realizaron revisión del expediente clínico, análisis de la autopsia y revisión bibliográfica. Presentación de caso: Se presenta el caso de un masculino de 39 años con antecedente de hipertensión pulmonar que consultó por disnea súbita. Se abordó el caso como un tromboembolismo pulmonar. El paciente presentó una evolución clínica tórpida y falleció. La autopsia reveló un aneurisma de la arteria pulmonar. Conclusión: Los aneurismas de la arteria pulmonar son poco frecuentes. La presentación clínica es inespecífica. Los métodos diagnósticos más fiables son la sospecha clínica y los métodos de imagen, sin embargo siguen siendo motivo de muerte súbita y repentina; cuyo hallazgo es postmorten.

Abstract Objective: Correlate the generalities of etiology, pathogenesis, clinical presentation and current diagnostic methods available for pulmonary artery aneurysm with sudden death of these patients. Materials and methods: Review of medical record, autopsy analysis and scientific literature. Case presentation: A 39-year-old male with a history of pulmonary hypertension, who consulted for sudden dyspnea. The case was approached as a pulmonary thromboembolism. The patient presented bad clinical evolution and died. Autopsy revealed an aneurysm of the pulmonary artery. Conclusion: Aneurysms of the pulmonary artery are rare. The clinical presentation is nonspecific. The most reliable diagnostic methods are clinical suspicion and imaging methods, however they remain a cause of sudden death; whose finding is postmortem.