A Case of Massive Hepatic Infarction in a Patient with HELLP Syndrome
08 January 2019
21 January 2019
19 March 2019 (online)
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.
- 1 Tufano A, Coppola A, Maruotti GM, Martinelli P, Cerbone AM, Di Minno G. HELLP syndrome and its relation with the antiphospholipid syndrome. Blood Transfus 2014; 12 (01) 114-118
- 2 Suzumori N, Obayashi S, Kumagai K, Goto S, Yoshida A, Sugiura-Ogasawara M. A case of microangiopathic antiphospholipid-associated syndromes during pregnancy: review of the literature. Case Rep Med 2012; 2012: 827543
- 3 Lam MTC, Dierking E. Intensive care unit issues in eclampsia and HELLP syndrome. Int J Crit Illn Inj Sci 2017; 7 (03) 136-141
- 4 Mikolajczyk AE, Renz J, Diaz G, Alpert L, Hart J, Te HS. Massive hepatic infarction caused by HELLP syndrome. ACG Case Rep J 2017; 4: e81
- 5 Heller CS, Elliott JP. High-order multiple pregnancies complicated by HELLP syndrome. A report of four cases with corticosteroid therapy to prolong gestation. J Reprod Med 1997; 42 (11) 743-746
- 6 Mao M, Chen C. Corticosteroid therapy for management of hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome: a meta-analysis. Med Sci Monit 2015; 21: 3777-3783
- 7 Eser B, Guven M, Unal A. , et al. The role of plasma exchange in HELLP syndrome. Clin Appl Thromb Hemost 2005; 11 (02) 211-217
- 8 Hammoud GM, Ibdah JA. Preeclampsia-induced liver dysfunction, HELLP syndrome, and acute fatty liver of pregnancy. Clin Liver Dis 2014; 4 (03) 69-73
- 9 Levine H, Zarghouni M, Cannon W. Imaging manifestations of a dreaded obstetric complication in the immediate postpartum period. Proc Bayl Univ Med Cent 2014; 27 (02) 141-142
- 10 Chou M-M, Chen Y-F, Kung H-F. , et al. Extensive hepatic infarction in severe preeclampsia as part of the HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets): evolution of CT findings and successful treatment with plasma exchange therapy. Taiwan J Obstet Gynecol 2012; 51 (03) 418-420
- 11 Barton JR, Sibai BM. Hepatic imaging in HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count). Am J Obstet Gynecol 1996; 174 (06) 1820-1825 , discussion 1825–1827
- 12 Han X, Fan Y, Yu Y. Two cases of severe preeclampsia were diagnosed with HELLP postpartum after caesarian section. Case Rep Obstet Gynecol 2014; 2014: 747510