Acute fatty liver of pregnancy (AFLP) is a rare but life-threatening obstetric emergency, often complicated by multiorgan dysfunction syndrome (MODS). We report a case of a 25-year-old primigravida woman at 34 weeks and 7 days of a twin pregnancy presenting with abdominal pain, nausea, and vomiting for three days. Diagnosis was established based on clinical, laboratory, and imaging findings. Prompt multidisciplinary management, including termination of pregnancy and intensive care support, resulted in a favorable maternal outcome. This case underscores the importance of early recognition and aggressive intervention in AFLP complicated by MODS.