Asploro Journal of Biomedical and Clinical Case Reports

Asploro Journal of Biomedical and Clinical Case Reports

Sarmento AMP¹, Oliveira ACT¹, Barbosa APXP¹, Campos CS¹, Porto JAS¹, Esteves LF¹, de Morais LC¹, Vilano LS¹, Cerqueira MSM¹, Martins MC¹, Cerceau PS¹, Amaral PHS¹, Ferreira RRMS¹, Pires RA¹, Albuquerque RDV¹, de Souza SGTPG¹, Bertges ER⁵, Panconi CR^2,3,4, Almeida FAMB¹, Zimmermmann JB^1,2,3,4*
¹Barbacena Medical School, Barbacena, Minas Gerais State, Brazil
²Medical School of Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais State, Brazil
³Zimmermmann Obstetrics and Gynecology Clinic, Brazil
⁴High Risk Prenatal Care, Brazil
⁵Juiz de Fora Medical and Health Sciences School, SUPREMA, Gastroenterology, Brazil

Corresponding Author: Juliana Barroso Zimmermmann ^{ORCID ID}
Address: Gynecology and Obstetrics Service, Barbacena School of Medicine (FUNJOBE), Barbacena, Minas Gerais State, Brazil.
Received date: 02 October 2020; Accepted date: 30 October 2020; Published date: 07 November 2020

Citation: Sarmento AMP, Oliveira ACT, Barbosa APXP, Campos CS, Porto JAS, Esteves LF, de Morais LC, Vilano LS, Cerqueira MSM, Martins MC, Cerceau PS, Amaral PHS, Ferreira RRMS, Pires RA, Albuquerque RDV, de Souza SGTPG, Bertges ER, Panconi CR, Almeida FAMB, Zimmermmann JB. Acute Hepatitis in Pregnancy: A Case Report. Asp Biomed Clin Case Rep. 2020 Nov 07;3(3):225-33.

Copyright © 2020 Sarmento AMP, Oliveira ACT, Barbosa APXP, Campos CS, Porto JAS, Esteves LF, de Morais LC, Vilano LS, Cerqueira MSM, Martins MC, Cerceau PS, Amaral PHS, Ferreira RRMS, Pires RA, Albuquerque RDV, de Souza SGTPG, Bertges ER, Panconi CR, Almeida FAMB, Zimmermmann JB. 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.

Keywords: Acute Hepatitis, Autoimmunity, Hepatitis, Pregnancy, Vitamin

Abstract

Introduction: Several changes occur in women’s body during pregnancy, as well as several pathologies can arise at this period, such as hepatitis. It is very important to have the correct diagnosis and proper treatment for pregnant women because liver diseases can increase maternal and/or fetal morbidity and mortality rates.
Case Report: Patient in the age group 32 years, G2P0A1, thrombophilic, using ASA, enoxaparin, folate, and B-complex, reported jaundice, low fever, and pruritus in the 32^nd week of pregnancy. Laboratory exams showed high levels of direct hyperbilirubinemia and aminotransferases, with negative serology results for the most common viruses and autoimmunity markers. Hypervitaminosis B12 was an additional finding; it was canceled. The patient had a satisfactory recovery after support treatment.
Discussion: Hepatitis has several etiologies; it is caused by infections, medications, or triggered by the immune system. The main infectious agents causing hepatitis A, B, C, and E; Dengue, Zika, HTLV, cytomegalovirus, toxoplasmosis, rubella, and brucellosis were screened in the reported case – the patient was negative for all of them. Other possible diagnoses, such as acute liver steatosis of pregnancy, portal thrombosis, and autoimmune hepatitis were excluded. Hepatitis caused by medicines was not confirmed because clinical and laboratory exams showed improvement in the patient’s clinical condition even with ASA and enoxaparin administration. The patient had high vitamin B12 level, which can be a liver damage marker. Transaminases and bilirubin showed a progressive decrease after the treatment; both patient and newborn had a satisfactory recovery. The reported condition was caused by a combination of factors, such as pregnancy hormone levels, unidentified infection, and possible predisposition to develop the disease. The patient remains under hematological and hepatological follow up, but there is no record of relapse, so far.