Liver infarction in a woman with systemic lupus erythematosus and secondary anti-phospholipid and HELLP syndrome.
We report a 39-year-old primigravida, a case of systemic lupus erythematosus (SLE) and secondary anti-phospholipid syndrome (APS) with a smooth antenatal course who delivered by caesarean for non-reassuring foetal heart rate. On day 2 postoperatively, she developed a sudden severe colicky upper abdominal pain with tachypnoea, dyspnoea, and tachycardia, and blood pressure (BP) reaching 150/95 mmHg. Computed tomography of the abdomen revealed lesions consistent with liver infarction. She developed haemolytic anaemia, elevated liver enzymes, and low platelets (HELLP syndrome); heparin and methylprednisolone were started. On day 3, BP normalized, respiratory symptoms improved but abdominal symptoms persisted. Methylprednisolone was increased to 80 mg/day on day 8 when she had significant clinical response and was discharged on day 16. This case emphasizes that a morbid clinical course including liver infarction should be anticipated in patients with SLE and APS complicated with HELLP syndrome.
Sakhel
K
K
Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon.
Usta
I M
IM
Hannoun
A
A
Arayssi
T
T
Nassar
A H
AH
D015746:Abdominal Pain / Q000209:etiology / Q000473:pathology; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D016736:Antiphospholipid Syndrome / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D005260:Female; D017359:HELLP Syndrome / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D006801:Humans; D007238:Infarction / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D008099:Liver / Q000098:blood supply* / Q000201:enzymology; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000473:pathology; D008775:Methylprednisolone / Q000627:therapeutic use; D011247:Pregnancy; D011248:Pregnancy Complications
D000893:Anti-Inflammatory Agents; D008775:Methylprednisolone