HELLP Syndrome with Unusual Features in a Rare Setting

Abstract

HELLP (Hemolysis, Elevated Liver enzymes, and Low Platelet) syndrome is a rare disorder exclusively associated with pregnancy. It occurs mostly during the antepartum period in about 70% of cases but could also occur during the post-partum period in about 30% of reported cases especially during the first 48 hours following delivery. The syndrome is mostly reported among multiparous Caucasians in association with severe preeclampsia, hypertension, and proteinuria. It is rarely reported within Nigeria and the post-partum variant has never been documented among women of Nigerian origin in the literature to date. Herein, we report a very unusual case of HELLP syndrome in a very rare setting that developed eleven days post-partum without the usual features of hypertension and proteinuria in a 26-year-old G1P1. Upon presentation, she was promptly diagnosed and aggressively managed using standard protocols by a multidisciplinary medical team of specialists. She developed acute kidney injury (KDIGO stage 1) in the course of management of which she required conservative management. Remarkably, with supportive care, all the clinical and laboratory derangements, including hepatic and renal functions, normalized after seven days on admission. Her condition remained stable during weekly follow-up visits for four consecutive weeks. This case and its management protocols reinforce the need for a high index of clinical suspicion for this dreaded disorder and its prompt diagnosis/aggressive management even in very rare circumstances and settings.