HELLP Syndrome Complicated with Postpartum Subcapsular Ruptured Liver Hematoma and Purtscher-Like Retinopathy

Abstract

Purtscher's retinopathy is usually associated with trauma, acute pancreatitis, vasculitis, lupus, and bone fractures. It was rarely described postpartum in patients with preeclampsia as well as associated with HELLP syndrome. We present a case of a multiparous patient aged 44 with severe preeclampsia and postpartum HELLP syndrome complicated with Purtscher-like retinopathy and large ruptured subcapsular liver hematoma that required emergency abdominal surgery after premature delivery of a dead fetus. Postsurgical outcome was favorable regarding both liver function and visual acuity.

Development of Purtscher-like retinopathy after pre-eclampsia combined with acute pancreatitis

“…Purtscher's retinopathy is a rare condition, usually associated with severe head injury and blunt thoracic trauma, but also seen in patients with acute pancreatitis, fat embolism, renal failure, pre-eclampsia, childbirth and connective tissue disorders with vasculitis [4-8]. Especially Purtscher-like retinopathy is used to describe the retinopathy seen in conditions other than trauma [5].…”

Subcapsular liver hematoma as a complication of an atypical hemolytic uremic syndrome

“…In HELLP syndrome, SLH is thought to be a consequence of hepatic blood flow obstruction due to fibrin deposits within hepatic sinusoids, resulting in periportal necrosis and intrahepatic hemorrhage. 10 Likewise, we believe vascular rupture in aHUS might result from hepatic blood flow obstruction secondary to complement-induced microvascular thrombosis. Other possible contributors for bleeding diathesis in our patient were uremic platelet dysfunction, difficult-to-control hypertension and heparinization during dialysis and PEX.…”

Subcapsular liver hematoma as a complication of an atypical hemolytic uremic syndrome

“…2 Few hemorrhagic events were also reported in patients with infection-induced HUS and in secondary causes of ATM. 10 Likewise, we believe vascular rupture in aHUS might result from hepatic blood flow obstruction secondary to complement-induced microvascular thrombosis. [6][7][8] SLH is a rare event that is mainly related with pregnancyinduced hypertension (preeclampsia and HELLP syndrome) and primary or metastatic liver tumors.…”