Acute fatty liver of pregnancy (AFLP) was first described in 1940. It is a rare condition which affects 1:20 000 births a year¹ and can cause serious hepatic dysfunction. Mortality rates can range from 5%, with intensive treatment and soar to 75% if misdiagnosed¹. The pathophysiology of AFLP is poorly understood but it is usually observed in later pregnancy, 30-38 weeks.² We present a case of AFLP occurring in a woman whose initial symptoms could have been attributed to intrahepatic cholestasis of pregnancy (ICP).