Acute fatty liver of pregnancy (AFLP) is a rare but potentially life-threatening obstetric complication, with an estimated incidence ranging from 1 in 7,000 to 20,000 pregnancies. Despite advances in diagnosis and treatment, its high maternal–fetal morbidity and mortality rates make it a true clinical challenge, particularly in hospitals with limited resources. This paper presents a complex clinical case with multiple variants simulating other pathologies, along with a comprehensive literature review that integrates international, regional, and national evidence. The analysis focuses on the diagnostic difficulty posed by differential entities such as HELLP syndrome, intrahepatic cholestasis, viral hepatitis, autoimmune diseases, dyslipidemias, and abdominal tumors. In addition, key clinical and laboratory tools—particularly the Swansea criteria—are highlighted as essential for standardizing diagnosis when specialized tests are unavailable. Based on the literature synthesis and the case analysis, a diagnostic algorithm and a table of pragmatic strategies tailored for low-resource settings are proposed, aiming to reduce delays and improve maternal–fetal outcomes.
Libertad et al. (2026) studied this question.