Cargando…

A case of massive hepatic infarction in severe preeclampsia as part of the HELLP syndrome

Hepatic infarction is a rare and fatal complication associated with hemolysis, elevated liver enzymes and low platelets syndrome. It can develop into fulminant liver failure and lead to death in 16% of cases. A 25-year-old woman, with unremarkable prenatal history, was sent to gynecological emergenc...

Descripción completa

Detalles Bibliográficos
Autores principales: El Allani, Linda, Benlamkaddem, Said, Berdai, Mohamed Adnane, Harandou, Mustapha
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The African Field Epidemiology Network 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7386275/
https://www.ncbi.nlm.nih.gov/pubmed/32774637
http://dx.doi.org/10.11604/pamj.2020.36.78.23302
_version_ 1783563919917318144
author El Allani, Linda
Benlamkaddem, Said
Berdai, Mohamed Adnane
Harandou, Mustapha
author_facet El Allani, Linda
Benlamkaddem, Said
Berdai, Mohamed Adnane
Harandou, Mustapha
author_sort El Allani, Linda
collection PubMed
description Hepatic infarction is a rare and fatal complication associated with hemolysis, elevated liver enzymes and low platelets syndrome. It can develop into fulminant liver failure and lead to death in 16% of cases. A 25-year-old woman, with unremarkable prenatal history, was sent to gynecological emergency unit for management of severe preeclampsia at 30 weeks and 4 days of pregnancy. Initial laboratory studies revealed aspartate aminotransferase at 290 U/L, alanine aminotransferase at 193 U/L and a normal value of hemoglobin, platelets and the prothrombin time. Behind the persistence of high blood pressure despite dual therapy, an emergent cesarean section was performed. However, two days after surgery, the patient accused an epigastric pain and was subsequently noted to have developed HELLP syndrome: thrombocytopenia (77000 /ul), anemia (hemoglobin 9.1 g/dL) and worsened liver injury (aspartate aminotransferase 2809 U/L; alanine aminotransferase 2502 U/L). A thoraco-abdominopelvic computed tomography (CT) was performed, which revealed massive hepatic infarction more marked on the right lobe, by showing the existence of diffuse hypodense plaques, poorly limited, not enhanced after injection, interesting all hepatic segments. The vascular permeability of the portal and subhepatic was preserved. During the surveillance, the laboratory tests worsened (hemoglobin = 4,6 g/dl; platelets count = 20000 /ul; WBC = 26000 /ul; CRP = 340 mg/l; albumin = 16 g/l, prothrombin time (PT) = 50%). The patient received antibiotics, she was transfused by red blood cells and platelets concentrates, she also received albumin with the pleural effusion drainage. The damaged hepatic areas stayed stable in control CT and the patient gradually improved here biological test, to become normal at 11 days after delivery. Hepatic infarction is an extraordinarily rare complication of preeclampsia. The diagnosis should be suspected by noting elevated liver enzymes, thrombocytopenia and typical images of hepatic infarction on abdominal CT. Early recognition and multidisciplinary management is necessary to prevent hepatic failure and death.
format Online
Article
Text
id pubmed-7386275
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher The African Field Epidemiology Network
record_format MEDLINE/PubMed
spelling pubmed-73862752020-08-07 A case of massive hepatic infarction in severe preeclampsia as part of the HELLP syndrome El Allani, Linda Benlamkaddem, Said Berdai, Mohamed Adnane Harandou, Mustapha Pan Afr Med J Case Report Hepatic infarction is a rare and fatal complication associated with hemolysis, elevated liver enzymes and low platelets syndrome. It can develop into fulminant liver failure and lead to death in 16% of cases. A 25-year-old woman, with unremarkable prenatal history, was sent to gynecological emergency unit for management of severe preeclampsia at 30 weeks and 4 days of pregnancy. Initial laboratory studies revealed aspartate aminotransferase at 290 U/L, alanine aminotransferase at 193 U/L and a normal value of hemoglobin, platelets and the prothrombin time. Behind the persistence of high blood pressure despite dual therapy, an emergent cesarean section was performed. However, two days after surgery, the patient accused an epigastric pain and was subsequently noted to have developed HELLP syndrome: thrombocytopenia (77000 /ul), anemia (hemoglobin 9.1 g/dL) and worsened liver injury (aspartate aminotransferase 2809 U/L; alanine aminotransferase 2502 U/L). A thoraco-abdominopelvic computed tomography (CT) was performed, which revealed massive hepatic infarction more marked on the right lobe, by showing the existence of diffuse hypodense plaques, poorly limited, not enhanced after injection, interesting all hepatic segments. The vascular permeability of the portal and subhepatic was preserved. During the surveillance, the laboratory tests worsened (hemoglobin = 4,6 g/dl; platelets count = 20000 /ul; WBC = 26000 /ul; CRP = 340 mg/l; albumin = 16 g/l, prothrombin time (PT) = 50%). The patient received antibiotics, she was transfused by red blood cells and platelets concentrates, she also received albumin with the pleural effusion drainage. The damaged hepatic areas stayed stable in control CT and the patient gradually improved here biological test, to become normal at 11 days after delivery. Hepatic infarction is an extraordinarily rare complication of preeclampsia. The diagnosis should be suspected by noting elevated liver enzymes, thrombocytopenia and typical images of hepatic infarction on abdominal CT. Early recognition and multidisciplinary management is necessary to prevent hepatic failure and death. The African Field Epidemiology Network 2020-06-09 /pmc/articles/PMC7386275/ /pubmed/32774637 http://dx.doi.org/10.11604/pamj.2020.36.78.23302 Text en © Linda El Allani et al. https://creativecommons.org/licenses/by/4.0 The Pan African Medical Journal (ISSN: 1937-8688). This is an Open Access article distributed under the terms of the Creative Commons Attribution International 4.0 License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case Report
El Allani, Linda
Benlamkaddem, Said
Berdai, Mohamed Adnane
Harandou, Mustapha
A case of massive hepatic infarction in severe preeclampsia as part of the HELLP syndrome
title A case of massive hepatic infarction in severe preeclampsia as part of the HELLP syndrome
title_full A case of massive hepatic infarction in severe preeclampsia as part of the HELLP syndrome
title_fullStr A case of massive hepatic infarction in severe preeclampsia as part of the HELLP syndrome
title_full_unstemmed A case of massive hepatic infarction in severe preeclampsia as part of the HELLP syndrome
title_short A case of massive hepatic infarction in severe preeclampsia as part of the HELLP syndrome
title_sort case of massive hepatic infarction in severe preeclampsia as part of the hellp syndrome
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7386275/
https://www.ncbi.nlm.nih.gov/pubmed/32774637
http://dx.doi.org/10.11604/pamj.2020.36.78.23302
work_keys_str_mv AT elallanilinda acaseofmassivehepaticinfarctioninseverepreeclampsiaaspartofthehellpsyndrome
AT benlamkaddemsaid acaseofmassivehepaticinfarctioninseverepreeclampsiaaspartofthehellpsyndrome
AT berdaimohamedadnane acaseofmassivehepaticinfarctioninseverepreeclampsiaaspartofthehellpsyndrome
AT harandoumustapha acaseofmassivehepaticinfarctioninseverepreeclampsiaaspartofthehellpsyndrome
AT elallanilinda caseofmassivehepaticinfarctioninseverepreeclampsiaaspartofthehellpsyndrome
AT benlamkaddemsaid caseofmassivehepaticinfarctioninseverepreeclampsiaaspartofthehellpsyndrome
AT berdaimohamedadnane caseofmassivehepaticinfarctioninseverepreeclampsiaaspartofthehellpsyndrome
AT harandoumustapha caseofmassivehepaticinfarctioninseverepreeclampsiaaspartofthehellpsyndrome