Hemophagocytic lymphohistiocytosis in early pregnancy: A rare and fatal diagnostic challenge.

Objective: This report details the complexities of diagnosing and treating rapid-onset multisystemic hemophagocytic lymphohistiocytosis (HLH) during pregnancy, as evidenced by a fatal case in early pregnancy with severe hematological and obstetric complications.

Case presentation: A 20-year-old pregnant woman in her second pregnancy presented at 8 weeks of gestation with abdominal pain, fever, and rectal bleeding. Laboratory tests revealed leukopenia, thrombocytopenia, and anemia, leading to immediate transfusion and intensive care unit admission. Despite intensive interventions, including vasopressors and antibiotics, the patient developed progressive organ failure, with disseminated intravascular coagulation, and suffered a fatal stroke.

Conclusions: This critical case with severe complications demonstrates the diagnostic and treatment challenges of rapid-onset HLH in early pregnancy. Early and accurate differential diagnosis in obstetric emergencies is vital for conditions such as HLH. This case highlights the importance of multifaceted care in managing pregnant patients with complex, atypical presentations.