title: Fulminant liver failure resulting from massive hepatic infarction associated with hemolysis, elevated liver enzymes, and low platelets syndrome.
abstract: Hepatic infarction is an extremely rare and fatal complication associated with hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome. It can develop into fulminant liver failure, which increases both maternal and neonatal mortality rates. A 34-year-old woman with no remarkable past medical history developed eclampsia after delivery at 40 weeks of gestation. Imaging indicated massive hepatic infarction and rupture followed by cardiac arrest and fulminant liver failure. Despite liver replacement therapy with plasma exchange and continuous hemodiafiltration, the patient gradually deteriorated with persistent bacterial infection until death at 98 days after delivery. The management of fulminant liver failure complicated with HELLP syndrome should be multidisciplinary. Liver transplantation, the only radical treatment for fulminant liver failure, is worth attempting, if applicable.
authors.affiliation: Department of Gynecology and Obstetrics, Toyota Memorial Hospital, Toyota, Aichi, Japan. masato.yoshihara.1209@gmail.com.
authors.forename: Masato
authors.initials: M
authors.lastname: Yoshihara
authors.affiliation: Department of Gynecology and Obstetrics, Toyota Memorial Hospital, Toyota, Aichi, Japan.
authors.forename: Michinori
authors.initials: M
authors.lastname: Mayama
authors.affiliation: Department of Gynecology and Obstetrics, Toyota Memorial Hospital, Toyota, Aichi, Japan.
authors.forename: Mayu
authors.initials: M
authors.lastname: Ukai
authors.affiliation: Department of Gynecology and Obstetrics, Toyota Memorial Hospital, Toyota, Aichi, Japan.
authors.forename: Sho
authors.initials: S
authors.lastname: Tano
authors.affiliation: Department of Gynecology and Obstetrics, Toyota Memorial Hospital, Toyota, Aichi, Japan.
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Kishigami
authors.affiliation: Department of Gynecology and Obstetrics, Toyota Memorial Hospital, Toyota, Aichi, Japan.
authors.forename: Hidenori
authors.initials: H
authors.lastname: Oguchi
mesh_terms: D000328:Adult; D017809:Fatal Outcome; D005260:Female; D017359:HELLP Syndrome / Q000175:diagnosis*; D006499:Hepatic Artery / Q000473:pathology*; D006801:Humans; D017114:Liver Failure, Acute / Q000150:complications* / Q000175:diagnosis* / Q000473:pathology; D011247:Pregnancy; D016896:Treatment Outcome
keywords: HELLP syndrome; continuous hemodiafiltration; fulminant liver failure; hepatic infarction; plasma exchange