CC BY-NC-ND 4.0 · AJP Rep 2019; 09(01): e84-e87
DOI: 10.1055/s-0039-1681028
Case Report
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

A Case of Massive Hepatic Infarction in a Patient with HELLP Syndrome

1  Department of Obstetrics and Gynecology, The University of Illinois at Chicago, Chicago, Illinois
,
Micaela Della Torre
2  Division of Maternal-Fetal Medicine, Department Obstetrics and Gynecology, The University of Illinois at Chicago, Chicago, Illinois
,
Anna R. Whelan
1  Department of Obstetrics and Gynecology, The University of Illinois at Chicago, Chicago, Illinois
,
Sophia M. Rodriguez
1  Department of Obstetrics and Gynecology, The University of Illinois at Chicago, Chicago, Illinois
,
Laura M. DiGiovanni
2  Division of Maternal-Fetal Medicine, Department Obstetrics and Gynecology, The University of Illinois at Chicago, Chicago, Illinois
› Author Affiliations
Further Information

Publication History

08 January 2019

21 January 2019

Publication Date:
19 March 2019 (online)

  

Abstract

Background Hepatic infarction is an exceedingly rare complication of hemolysis, elevated liver enzymes, and low platelets syndrome. Few cases have been described in the medical literature and the true incidence remains unknown. It can lead to fulminant liver failure, liver transplant, or death if not promptly addressed.

Case Report A 22-year-old primigravida presented with right upper quadrant and epigastric pain at 28 weeks' gestation. She had severely elevated blood pressures requiring intravenous antihypertensives as well as proteinuria, thrombocytopenia, and mild transaminitis. Within 6 hours of admission, her rapidly rising liver function tests (LFTs) necessitated urgent delivery by primary cesarean section. Her liver enzymes continued to rapidly worsen postoperatively and immediate postpartum computed tomography of the abdomen and pelvis revealed massive hepatic infarction, 11 × 10 × 15 cm, of the right lobe of the liver. Her transaminases peaked at alanine transferase of 2,863 IU/L and aspartate transferase of 2,732 IU/L. She received supportive multidisciplinary intensive care, and LFTs returned to normal by postoperative day 20.

Conclusion Hepatic infarction is an extraordinarily rare complication of pre-eclampsia. Early recognition and prompt multidisciplinary management are vital to prevent catastrophic bleeding, hepatic failure, and death.