Significance Of Pre-Pregnancy Acne Fulminans As A Marker Of Dyslipedmia And Nash With Its Association Of Aflp

Abstract

Most frequent cause of acute liver failure in pregnancy is AFLP also known as acute fatty metamorphosis/acute yellow atrophy. Though it is known to be associated with autosomal recessive mitochondrial fatty acid oxidation abnormalities, a correlation has also been found with AFLP as a continuum of dyslipidemia and NASH, which is the most common hepatic manifestation of PCOS. Here 15 cases of pregnancy with AFLP were studied, where preconceptionally 13 patients had PCOS and out of which 9 patients had acne fulminans, dyslipidemia and NASH. Moreover, in pregnancies with h/o acne fulminans, dyslipidemia and NASH, AFLP progressed at rapid rate with earlier onset and landed in decompensated liver failure compared with sporadic cases. As pregnancy progresses, insulin resistance increases, levels of lipoprotein particles and lipids are in atherogenic range which allows for proper nutrients for fetus. Though cases of AFLP are known to occur due to LCHAD deficiency, these changes in lipid metabolism, insulin resistance in a setting of pre-pregnancy dyslipidemia & NASH can lead to acute fatty metamorphosis, thus culminating in acute fatty liver of pregnancy. There by concluding pre-pregnancy acne fulminans as a manifestation of dyslipidemia &NASH helps in identifying pregnant women at risk of AFLP..