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  • Rapidly progressing HELLP syndrome and massive liver destruction in a 22-year-old female pregnant with monochorionic diamniotic gemelli

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Reminder of important clinical lesson
Case report
Rapidly progressing HELLP syndrome and massive liver destruction in a 22-year-old female pregnant with monochorionic diamniotic gemelli
  1. Julie Brøsen1,
  2. Dorte Stærk2,
  3. Anne-Dorthe Feldthusen3,
  4. Allan Rasmussen4 and
  5. Mette Brimnes Damholt1
  1. 1Nephrology, Rigshospitalet, Copenhagen, Denmark
  2. 2Radiology, Rigshospitalet, Copenhagen, Denmark
  3. 3Department of Gynecology and Obstetrics, Næstved Sygehus, Næstved, Denmark
  4. 4Gastrointestinal surgery, Rigshospitalet, Copenhagen, Denmark
  1. Correspondence to Dr Mette Brimnes Damholt; mette.brimnes.damholt{at}regionh.dk

Abstract

Haemolysis Elevated Liver parameters and Low Platelets (HELLP) syndrome can present with abdominal pain as the only symptom. It can be rapid with failure of multiple organs and is a cause of maternal death. A 22-year-old female pregnant with twins contacted her local hospital due to abdominal pain. Within 20 hours of the debut of the abdominal pain, a caesarean section was performed, the patient was re-operated due to the suspicion of abdominal bleeding. Bescause she was hypotensive and blood tests showed signs of liver destruction and acidosis, she was transferred to the intensive care unit (ICU). During an admission of 40 days, the patient received 5 plasmapheresis treatments and 10 courses of haemodialysis. CT scans showed massive liver haematomas intraparenchymal and subcapsular. The CT scan images are very interesting and included in the case report.

This case presents a good prognosis after a rapid progression of HELLP in spite of a dramatic clinical presentation. This topic is of great interest to a wide spectre of clinicians, as an early multidisciplinary approach is necessary.

  • adult intensive care
  • pregnancy
  • acute renal failure
  • dialysis

https://doi.org/10.1136/bcr-2019-229458

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    Footnotes

    • Contributors JB contributed on collecting data from the journal, drafting the case, contact to the patient and critical revision of the case. DS contributed to describing the CT scans and making the images available. ADF contributed to critical revision of the case describing the initial course of the patient case with emphasis on the obstetric details. AR contributed to the revision of the case. MBD contributed to drafting the work and revising it critically for important intellectual content. JB, DS, ADF, AR and MBD gave their final approval of the version published.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.