Acute fatty liver of pregnancy(AFLP) is an obstetric emergency can result in maternal and fetal complications including death. The exact pathology of disease is unknown but abnormality in the fatty acid metabolism play an important role. The disease usually affects in third trimester and immediate postpartum(1). The diagnosis of AFLP usually based on clinical presentation and compatible laboratory finding. Intensive care unit admission with supportive management and immediate delivery irrespective of gestational age are main stay of treatment(2). We report a case of 26-year-old mother who was diagnosed with AFLP in second day of postpartum.

Tetanus is a disease caused by the toxin produced by Clostridium tetani, a Gram negative anaerobic spore forming bacillus. Infection acquired from body piercing and puncture wound; intravenous drug abuse, surgical interventions, septic abortion and through infected umbilical stump. After inoculation C.tetani transform into a vegetative rod shaped bacterium and produces metalloproteases such as tetanospasmin and tetanolysin. Tetanospasmin is responsible for painful muscle rigidity and autonomic instability via inactivating inhibitory neurotransmission. The role of tetanolysin is not known.

Infective endocarditis may be acquired in the community or in the context of health care exposure. (1) and it associated with not only cardiac complications but also renal, neurologic, musculoskeletal, and systemic complications related to the infection, such as embolization, metastatic infection, and mycotic aneurysm. Staphylococcus aureus is most frequently associated with these complications. We report a case of 41 year old man who presented with fever and developed heart failure due to multiple perforated aortic valves with aortic regurgitation. This was successfully managed by aortic valve replacement, antibiotics and hemodialysis