The Effect of Prolonged Antenatal Intravenous Immunoglobulin Treatment in Preventing Gestational Alloimmune Liver Disease-A Case Series with Literature Review

Abstract

Background Gestational alloimmune liver disease (GALD) is characterized by maternal IgG-directed fetal hepatocyte damage and can lead to severe liver failure and fetal or infant death. Moreover, GALD is associated with a near 90% risk of recurrence in subsequent pregnancies. Case We present a case of a newborn patient delivered to a 32-year-old G2P1000 mother who received prolonged antenatal intravenous immunoglobulin (IVIG) treatment during the current pregnancy due to the neonatal death of the first child from GALD-related liver failure. Postnatal testing, including a liver magnetic resonance imaging (MRI) and buccal biopsy of this newborn, showed normal morphology of the liver without any abnormal iron deposition. Additional laboratory testing showed a lack of any liver injury. Conclusion This case supports the use of antenatal IVIG immunotherapy to prevent the recurrence of GALD in subsequent pregnancies. Key Points GALD can lead to severe fetal liver injury.GALD is highly recurrent in subsequent pregnancies.Prophylactic IVIG may prevent GALD recurrence.

Keywords: antenatal IVIG; fetal liver injury; gestational alloimmune liver disease; neonatal hemochromatosis; recurrence.

Fig. 1

( a ) In-phase and ( b ) out-of-phase T1 GRE imaging showing no abnormal hepatic signal dropout.

Fig. 2

MR brain T2 gradient echo sequence demonstrating no evidence of iron deposition.

Fig. 3

MR venography of the brain demonstrating loss of flow-related signal in the right transverse sinus, sigmoid sinus, and internal jugular vein, compatible with dural venous sinus thrombosis.