{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,17]],"date-time":"2025-09-17T15:05:01Z","timestamp":1758121501245,"version":"3.44.0"},"reference-count":27,"publisher":"BMJ","issue":"6","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,6,2]]},"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:p>Gestational alloimmune liver disease (GALD) is a rare pregnancy complication involving maternal antibody-mediated fetal liver injury that recurs in 90% of affected pregnancies. The fetal and neonatal mortality rate is high, up to 82%, and affected fetuses can develop fetal hydrops, growth restriction, and oligohydramnios. Intravenous immunoglobulin (IVIG) administration can prevent GALD recurrence.<\/jats:p>\n               <jats:p>We present a patient whose three live births were impacted by GALD. Her first pregnancy was an elective termination. Her second pregnancy resulted in neonatal demise due to autopsy-proven GALD. Her third pregnancy was complicated by liver injury secondary to biopsy-proven drug-induced liver injury (DILI) after IVIG administration and resulted in precipitous preterm twin delivery. In her fourth pregnancy, she received IVIG and high-dose steroids and did not develop DILI; the infant, delivered preterm due to GALD, died due to complications of prematurity.<\/jats:p>\n               <jats:p>GALD is a highly recurrent condition that results in significant neonatal mortality. In this rare case of DILI due to IVIG administration, high-dose steroids treated DILI recurrence and prevented acute liver injury and may be beneficial to patients who are unable to tolerate IVIG due to liver injury.<\/jats:p>","DOI":"10.1136\/bcr-2025-265479","type":"journal-article","created":{"date-parts":[[2025,6,17]],"date-time":"2025-06-17T04:10:15Z","timestamp":1750133415000},"page":"e265479","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Gestational alloimmune liver disease treated with intravenous immunoglobulin resulting in maternal drug-induced liver injury"],"prefix":"10.1136","volume":"18","author":[{"given":"Tess E K","family":"Cersonsky","sequence":"first","affiliation":[{"name":"Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine, New York, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel L","family":"Kuhr","sequence":"additional","affiliation":[{"name":"Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine, New York, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tatyana","family":"Kushner","sequence":"additional","affiliation":[{"name":"Weill Cornell Medical College, New York, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jill","family":"Berkin","sequence":"additional","affiliation":[{"name":"Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine, New York, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,6,16]]},"reference":[{"key":"2025082701564687000_18.6.e265479.1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000001569"},{"key":"2025082701564687000_18.6.e265479.2","first-page":"73","article-title":"Drug-induced Liver Injury","volume":"6","author":"David","year":"2010","journal-title":"US Gastroenterol Hepatol Rev"},{"key":"2025082701564687000_18.6.e265479.3","doi-asserted-by":"publisher","DOI":"10.1002\/hep.26709"},{"key":"2025082701564687000_18.6.e265479.4","doi-asserted-by":"publisher","DOI":"10.1002\/hep.24481"},{"key":"2025082701564687000_18.6.e265479.5","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/j.ejogrb.2021.02.027","article-title":"Therapeutic plasma exchange in pregnancy: A literature review","volume":"260","author":"Wind","year":"2021","journal-title":"European Journal of Obstetrics & Gynecology and Reproductive Biology"},{"key":"2025082701564687000_18.6.e265479.6","doi-asserted-by":"crossref","first-page":"254","DOI":"10.5005\/jp-journals-11002-0029","article-title":"Neonatal Acute Liver Failure","volume":"1","author":"Grewal","year":"2022","journal-title":"Newborn"},{"key":"2025082701564687000_18.6.e265479.7","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/j.jpeds.2017.12.054","article-title":"The Effects of Gestational Alloimmune Liver Disease on Fetal and Infant Morbidity and Mortality","volume":"196","author":"Taylor","year":"2018","journal-title":"J Pediatr"},{"key":"2025082701564687000_18.6.e265479.8","doi-asserted-by":"publisher","DOI":"10.1002\/hep.23581"},{"key":"2025082701564687000_18.6.e265479.9","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0286432","article-title":"Hunting for the elusive target antigen in gestational alloimmune liver disease (GALD)","volume":"18","author":"Rieneck","year":"2023","journal-title":"PLoS One"},{"key":"2025082701564687000_18.6.e265479.10","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1016\/j.humpath.2014.09.010","article-title":"Elaboration of tubules with active hedgehog drives parenchymal fibrogenesis in gestational alloimmune liver disease","volume":"46","author":"Asai","year":"2015","journal-title":"Hum Pathol"},{"key":"2025082701564687000_18.6.e265479.11","doi-asserted-by":"crossref","first-page":"1474","DOI":"10.1002\/hep.31109","article-title":"Liver Diseases in the Perinatal Period: Interactions Between Mother and Infant","volume":"71","author":"Ibrahim","year":"2020","journal-title":"Hepatology"},{"key":"2025082701564687000_18.6.e265479.12","doi-asserted-by":"crossref","DOI":"10.3389\/frph.2023.1077304","article-title":"GALD: new diagnostic tip for early diagnosis - 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