Malaria in pregnant woman masquerading as HELLP syndrome.
Malaria may be complicated by development of thrombocytopenia, elevated liver enzymes, and/or hemolysis, which may be difficult to distinguish from HELLP (hemolytic anemia; elevated liver enzymes; low platelet count) syndrome in a pregnant patient. A 33-year-old woman developed a HELLP-like syndrome and persistent fever postpartum without symptoms of preeclampsia. A malaria blood smear was performed and was positive for Plasmodium falciparum. The patient was immediately treated with quinine. The follow-up was uneventful with total disappearance of fever and prompt resolution of biochemical signs of HELLP-like syndrome 3 days later. Malaria in a pregnant woman can masquerade as HELLP syndrome. The wide overlap in symptoms (headache, malaise, digestive symptoms) does not suggest that symptoms would be effective in differentiating malaria and preeclampsia. A recent travel in endemic area, associated with malaria blood smear and clinic examination, should be the key of the differential diagnosis.
Ducarme
Guillaume
G
Department of Obstetrics and Gynecology, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, 100, Boulevard du Général Leclerc, 92110 Clichy, France. g.ducarme@gmail.com
Thuillier
Claire
C
Wernet
Anne
A
Bellier
Claire
C
Luton
Dominique
D
D000328:Adult; D000962:Antimalarials / Q000627:therapeutic use; D003937:Diagnosis, Differential; D005260:Female; D005334:Fever / Q000469:parasitology; D017359:HELLP Syndrome / Q000175:diagnosis; D006801:Humans; D016778:Malaria, Falciparum / Q000175:diagnosis* / Q000188:drug therapy; D010963:Plasmodium falciparum / Q000302:isolation & purification; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis*; D011803:Quinine / Q000627:therapeutic use
D000962:Antimalarials; D011803:Quinine