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