COVID-19 and HELLP Syndrome, uncertain diagnosis: Case report

Abstract

BACKGROUND: It is possible that the hyperinflammatory state in pregnant patients with COVID-19 is associated with hypoxic lesions in the placenta, which induce a clinical and biochemical picture similar to that of preeclampsia and HELLP syndrome. CLINICAL CASE: 40-year-old patient, with a history of primary infertility, with 33.1 weeks of pregnancy achieved by in vitro fertilization and embryo transfer. She was admitted to the emergency department due to hypertensive crisis accompanied by respiratory distress, hemolysis, hyperbilirubinemia and increased lactate dehydrogenase, elevated liver enzymes, thrombocytopenia and proteinuria. It was decided to terminate the pregnancy due to a suspected diagnosis of HELLP syndrome and probable acute pulmonary edema secondary to preeclampsia, with severity criteria. During the immediate postpartum period, chest CT scan showed pulmonary changes due to SARS-CoV-2 pneumonia, CORADS classification 5. During her stay in intensive care, she experienced clinical and biochemical improvement and was discharged on the sixth day after hospitalization. CONCLUSION: In this case we found similarity of the clinical picture and biochemical alterations of SARS-CoV-2 with preeclampsia and HELLP syndrome. To avoid in treatment and complications associated with late diagnosis it is important to establish the differential diagnosis.