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Early HELLP Syndrome or Catastrophic Antiphospholipid Syndrome? A Diagnostic Dilemma

Hypertensive disorders of pregnancy typically occur in the third trimester, with earlier presentations associated with underlying disorders such as antiphospholipid syndrome (APLS). We describe a case of a young primigravida presenting at 15 weeks 6 days gestation with epigastric pain, vomiting, new...

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Autores principales: Bae, Suhwoo, Comfort, Lizelle, Ng, Jason, Sarkar, Kumar, Pachtman, Sarah
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10225157/
https://www.ncbi.nlm.nih.gov/pubmed/37252601
http://dx.doi.org/10.7759/cureus.38244
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author Bae, Suhwoo
Comfort, Lizelle
Ng, Jason
Sarkar, Kumar
Pachtman, Sarah
author_facet Bae, Suhwoo
Comfort, Lizelle
Ng, Jason
Sarkar, Kumar
Pachtman, Sarah
author_sort Bae, Suhwoo
collection PubMed
description Hypertensive disorders of pregnancy typically occur in the third trimester, with earlier presentations associated with underlying disorders such as antiphospholipid syndrome (APLS). We describe a case of a young primigravida presenting at 15 weeks 6 days gestation with epigastric pain, vomiting, new-onset severe-range hypertension, and subsequent development of anemia, thrombocytopenia, and transaminitis. Antiphospholipid antibodies (aPL) were triple-positive and imaging was negative for thrombosis. She was treated with aspirin, therapeutic anticoagulation, and ultimately dilatation and evacuation with initial postoperative improvement. Her symptoms returned postoperative day 3 and resolved following re-initiation of therapeutic anticoagulation. The differential diagnosis for hypertensive disorders of pregnancy is wide, particularly in second-trimester gestation, and includes catastrophic antiphospholipid syndrome (CAPS), lupus flare, microangiopathic anemias, and acute fatty liver of pregnancy. This case was an atypical presentation not clearly explained by any of the above diagnoses and required a multidisciplinary approach. Obstetric patients with high-risk aPL must be meticulously investigated with a broad differential to guide diagnosis and treatment.
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spelling pubmed-102251572023-05-29 Early HELLP Syndrome or Catastrophic Antiphospholipid Syndrome? A Diagnostic Dilemma Bae, Suhwoo Comfort, Lizelle Ng, Jason Sarkar, Kumar Pachtman, Sarah Cureus Obstetrics/Gynecology Hypertensive disorders of pregnancy typically occur in the third trimester, with earlier presentations associated with underlying disorders such as antiphospholipid syndrome (APLS). We describe a case of a young primigravida presenting at 15 weeks 6 days gestation with epigastric pain, vomiting, new-onset severe-range hypertension, and subsequent development of anemia, thrombocytopenia, and transaminitis. Antiphospholipid antibodies (aPL) were triple-positive and imaging was negative for thrombosis. She was treated with aspirin, therapeutic anticoagulation, and ultimately dilatation and evacuation with initial postoperative improvement. Her symptoms returned postoperative day 3 and resolved following re-initiation of therapeutic anticoagulation. The differential diagnosis for hypertensive disorders of pregnancy is wide, particularly in second-trimester gestation, and includes catastrophic antiphospholipid syndrome (CAPS), lupus flare, microangiopathic anemias, and acute fatty liver of pregnancy. This case was an atypical presentation not clearly explained by any of the above diagnoses and required a multidisciplinary approach. Obstetric patients with high-risk aPL must be meticulously investigated with a broad differential to guide diagnosis and treatment. Cureus 2023-04-28 /pmc/articles/PMC10225157/ /pubmed/37252601 http://dx.doi.org/10.7759/cureus.38244 Text en Copyright © 2023, Bae et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Obstetrics/Gynecology
Bae, Suhwoo
Comfort, Lizelle
Ng, Jason
Sarkar, Kumar
Pachtman, Sarah
Early HELLP Syndrome or Catastrophic Antiphospholipid Syndrome? A Diagnostic Dilemma
title Early HELLP Syndrome or Catastrophic Antiphospholipid Syndrome? A Diagnostic Dilemma
title_full Early HELLP Syndrome or Catastrophic Antiphospholipid Syndrome? A Diagnostic Dilemma
title_fullStr Early HELLP Syndrome or Catastrophic Antiphospholipid Syndrome? A Diagnostic Dilemma
title_full_unstemmed Early HELLP Syndrome or Catastrophic Antiphospholipid Syndrome? A Diagnostic Dilemma
title_short Early HELLP Syndrome or Catastrophic Antiphospholipid Syndrome? A Diagnostic Dilemma
title_sort early hellp syndrome or catastrophic antiphospholipid syndrome? a diagnostic dilemma
topic Obstetrics/Gynecology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10225157/
https://www.ncbi.nlm.nih.gov/pubmed/37252601
http://dx.doi.org/10.7759/cureus.38244
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