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CC BY-NC-ND 4.0 · AJP Rep 2024; 14(04): e254-e258
DOI: 10.1055/a-2444-7155
Case Report

Drug-induced Liver Injury from Intravenous Immunoglobulin for Prevention of Recurrent Gestational Alloimmune Liver Disease: A Clinical Catch-22

Jessica A. Meyer 
1   Department of Obstetrics and Gynecology, NYU Grossman School of Medicine, New York, New York
,
Jenna S. Silverstein
1   Department of Obstetrics and Gynecology, NYU Grossman School of Medicine, New York, New York
,
Kristen M. Thomas
2   Department of Pathology, NYU Grossman School of Medicine, New York, New York
,
Sara G. Brubaker
3   Division of Maternal–Fetal Medicine, Department of Obstetrics and Gynecology, Bellevue Hospital Center, New York, New York
4   Division of Maternal–Fetal Medicine, Department of Obstetrics and Gynecology, NYU Langone Health, New York, New York
,
Judith L. Chervenak
3   Division of Maternal–Fetal Medicine, Department of Obstetrics and Gynecology, Bellevue Hospital Center, New York, New York
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Abstract

Gestational alloimmune liver disease (GALD) is a rare autoimmune syndrome in which maternal antibodies lead to in utero fetal hepatocyte destruction, often presenting as neonatal liver failure and hemochromatosis. Antenatal intravenous immunoglobulin (IVIG) is generally accepted to be safe in pregnancy with demonstrable benefits for reducing GALD recurrence risk in subsequent pregnancies. Here we present a case of a 33-year-old woman with a prior neonatal demise due to GALD who received multiple prophylactic IVIG infusions in a subsequent twin pregnancy complicated by maternal jaundice and acute hepatitis. A liver biopsy demonstrated hepatocellular injury with bridging necrosis and cholestatic features consistent with drug-induced liver injury. This case demonstrates the importance of close clinical monitoring during IVIG therapy and the need for further research into alternative prophylaxis options for GALD.

Key Points

  • GALD is a rare antibody-mediated autoimmune syndrome with high recurrence risk.

  • IVIG can be effective in reducing risk of GALD recurrence and fetal loss.

  • Patient's receiving ongoing IVIG therapy should be closely monitored for developing adverse effects, including DILI.

Keywords

gestational alloimmune liver disease - drug-induced liver injury - pregnancy - transaminitis - liver - hepatocellular damage - liver dysfunction - antibodies - intravenous immunoglobulin


Publication History

Received: 08 September 2024

Accepted: 20 September 2024

Accepted Manuscript online:
17 October 2024

Article published online:
13 November 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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