{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T16:12:00Z","timestamp":1783440720779,"version":"3.54.6"},"reference-count":34,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T00:00:00Z","timestamp":1764115200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Acute liver injury during pregnancy is rare and predominantly associated with pregnancy-related conditions including acute fatty liver of pregnancy; Hemolysis, Elevated Liver Enzymes and Low Platelets syndrome; intrahepatic cholestasis of pregnancy; and preeclampsia. Drug-induced liver injury (DILI) is a less common and often overlooked cause of acute liver injury in pregnant patients. A literature search on acute liver injury during pregnancy and therapeutic plasma exchange was conducted, revealing the most common causative factors and syndromes. A 39-year-old woman was diagnosed with acute liver injury in the 23rd week of her third pregnancy and, upon extensive differential diagnoses, a suspicion of DILI occurred after the use of methyldopa. Methyldopa, the drug of choice for the treatment of hypertensive disorders of pregnancy, has a high safety profile for the developing fetus and is well tolerated by pregnant women, yet, in susceptible individuals, a hepatotoxic effect may occur. The drug was discontinued and symptomatic treatment with ursodeoxycholic acid and prednisone was implemented with marginal effect. Upon a multidisciplinary joint consultation, plasmapheresis procedures were introduced, granting a significant improvement in the patient\u2019s liver function and enabling the continuation of the pregnancy. Plasmapheresis treatment was safely and effectively used for the first time in the therapeutic process in a pregnant patient with DILI. Interdisciplinary cooperation of specialists with gastroenterology, nephrology, and obstetrics expertise is crucial to achieving a timely diagnosis and begin effective treatment for pregnant patients with acute liver injury.<\/jats:p>","DOI":"10.3390\/jcm14238385","type":"journal-article","created":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T11:43:22Z","timestamp":1764157402000},"page":"8385","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Plasmapheresis for Suspected Drug-Induced Liver Injury During Pregnancy: A Multidisciplinary Diagnostic and Therapeutic Challenge"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3685-7279","authenticated-orcid":false,"given":"Agnieszka","family":"Zakrzewska","sequence":"first","affiliation":[{"name":"Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdansk, 80-210 Gdansk, Poland"},{"name":"University Clinical Centre, 80-952 Gdansk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5311-3450","authenticated-orcid":false,"given":"Magdalena Emilia","family":"Grzybowska","sequence":"additional","affiliation":[{"name":"University Clinical Centre, 80-952 Gdansk, Poland"},{"name":"Department of Gynecology, Obstetrics and Neonatology, Medical University of Gda\u0144sk, 80-210 Gdansk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4510-9558","authenticated-orcid":false,"given":"Dariusz Grzegorz","family":"Wydra","sequence":"additional","affiliation":[{"name":"University Clinical Centre, 80-952 Gdansk, Poland"},{"name":"Department of Gynecology, Obstetrics and Neonatology, Medical University of Gda\u0144sk, 80-210 Gdansk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalia Katarzyna","family":"Mazur-Ejankowska","sequence":"additional","affiliation":[{"name":"University Clinical Centre, 80-952 Gdansk, Poland"},{"name":"Department of Gynecology, Obstetrics and Neonatology, Medical University of Gda\u0144sk, 80-210 Gdansk, Poland"},{"name":"First Doctoral School, Medical University of Gdansk, 80-210 Gdansk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6476-9095","authenticated-orcid":false,"given":"Krystian","family":"Adrych","sequence":"additional","affiliation":[{"name":"University Clinical Centre, 80-952 Gdansk, Poland"},{"name":"Department of Gastroenterology and Hepatology, Medical University of Gdansk, 80-210 Gdansk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5515-5072","authenticated-orcid":false,"given":"Leszek","family":"Tylicki","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdansk, 80-210 Gdansk, Poland"},{"name":"University Clinical Centre, 80-952 Gdansk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8210-8063","authenticated-orcid":false,"given":"Alicja","family":"D\u0119bska-\u015alizie\u0144","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdansk, 80-210 Gdansk, Poland"},{"name":"University Clinical Centre, 80-952 Gdansk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3439-4349","authenticated-orcid":false,"given":"Bogdan","family":"Biedunkiewicz","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdansk, 80-210 Gdansk, Poland"},{"name":"University Clinical Centre, 80-952 Gdansk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2324709618761754","DOI":"10.1177\/2324709618761754","article-title":"Drug-Induced Liver Injury: An Institutional Case Series and Review of Literature","volume":"6","author":"Gayam","year":"2018","journal-title":"J. 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