Acute fatty liver of pregnancy was found in a 30 year-old primiparous female. After delivery of a male infant on 9th month of pregnancy, symptoms of acute liver failure including semi-coma, jaundice and ascites appeared. Needle liver biopsy specimen showed cholestasis, microvesicular fat deposition in hepatocytes and minor cell necrosis. Electron microscopy showed the swollen mitochondria and damaged cristae. Small-vesicle lipid infiltration in cytosol was seen. Serum cholesterol and triglyceride was 126 mg/dl and 274 mg/dl, respectively. Quantitation of serum apolipoprotein concentrations showed normal apo B, increased apo E, and decreased apo AI, All levels. Analysis of plasma lipoproteins revealed the decrease of HDL2 and HDL3 levels. HDL2 fraction was rich in apo E and consisted of large-sized particles. In addition, triglyceride content of both density<1.006 g/ml fraction and 1.006<d<1.063g g/ml fraction was increased. Apo B48 level in d<1.006 fraction also increased. LDL fraction consisted of large-, intermediate- and normal-sized particles. These results suggest the defective removal of remnant lipoproteins and decreased synthesis of lipoproteins by the liver in this patient.
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