Síndrome de hiperestimulación ovárica grave con elevación transitoria de troponina I: a propósito de un caso

Abstract

Introduction

Ovarian hyperstimulation syndrome (OHSS) is a potentially serious complication of controlled ovarian stimulation, with risk of multi-organ involvement. We present a clinical case of severe OHSS that initially manifested with symptoms suggestive of cardiac involvement and transient troponin elevation, in which cardiac pathology was ultimately ruled out.

Main symptoms and/or clinical findings

A 26-year-old woman, with no cardiovascular history, presented with abdominal distension, nausea, and acute epigastric pain after follicular puncture in the context of controlled ovarian stimulation for egg donation.

Main diagnoses, therapeutic interventions, and outcomes

Severe OHSS was diagnosed with tense ascites, hemoconcentration, altered renal profile, and marked elevation of troponin I (1098 ng/L) and D-dimer. Given the suspicion of myocardial ischemia, cardiological studies were performed, ruling out cardiac pathology. Medical treatment with albumin and diuretics was initiated, with clinical resolution without the need for paracentesis. The patient was discharged after four days, with normalization of laboratory and echocardiographic parameters.

Conclusion

Severe OHSS may present with clinical signs and biomarkers suggestive of cardiac disease. This finding highlights the importance of considering troponin elevation in OHSS within the context of hemodynamic and/or endothelial dysfunction, rather than as a specific marker of myocardial ischemia. This is especially relevant in severe multi-organ clinical presentations where differential diagnosis is crucial.