Obstet Gynecol Sci.  2016 Sep;59(5):397-402. 10.5468/ogs.2016.59.5.397.

Hepatic infarction in a pregnant woman with antiphospholipid syndrome and triple antibody positivity: A case report focusing on catastrophic antiphospholipid syndrome

• Kim JH
• Yee C
• Kuk JY
• Choi SJ
• Oh SY
• Roh CR
• Kim JH

• KMID: 2391691
• DOI: http://doi.org/10.5468/ogs.2016.59.5.397

Abstract

Pregnant women with antiphospholipid syndrome (APS) carry a high risk of arterial or venous thrombosis. Such thrombotic conditions occur more frequently in patients with triple positivity to antiphospholipid antibodies or with high antibody titers. Hepatic infarction is a rare complication in pregnant women with APS, and it sometimes mimics HELLP syndrome. This report describes a preeclamptic pregnant woman with APS who had high titers of three antiphospholipid antibodies. She experienced severe epigastric pain with elevated liver enzymes; in addition, she had tachycardia and tachypnea. The clinical findings suggested hepatic infarction and pulmonary thromboembolism, a partial manifestation of catastrophic APS. Therefore, she underwent emergent cesarean section at 25+2 weeks of gestation. After the delivery, her laboratory test indicated HELLP-like features, and computed tomography confirmed hepatic infarction and pulmonary micro-thromboembolism. Here, we report a case of a partial manifestation of catastrophic APS in a pregnant woman with triple antibody positivity, including a brief literature review.

Keyword

Antiphospholipid antibodies; Catastrophic antiphospholipid syndrome; HELLP syndrome; Hepatic infarction; Triple antibody positivity

MeSH Terms

Antibodies, Antiphospholipid
Antiphospholipid Syndrome*
Cesarean Section
Female
HELLP Syndrome
Humans
Infarction*
Liver
Pregnancy
Pregnant Women*
Pulmonary Embolism
Tachycardia
Tachypnea
Venous Thrombosis
Antibodies, Antiphospholipid

Figure

• 

  Fig. 1 Laboratory result of our patient at her second pregnancy. AST, aspartate aminotransferase; ALT, alanine aminotransferase; LDH, lactate dehydrogenase; ACS, antenatal corticosteroid; GA, gestational age; POD, post-operative day.

• 

  Fig. 2 Radiologic finding of our patient at her second pregnancy. (A) Magnetic resonance cholangiography; at 25+1 weeks of gestation, the day before delivery, 4.5-cm-sized clustered appearance in liver segment 2 which indicated to liver abscess (arrowed). (B) Pulmonary embolism computed tomography; postoperative 1 day, revered halo sign was seen in both lower lung field which indicated pulmonary micro-thromboembolism (arrow head). (C-F) Contrast enhanced liver computed tomography, axial and coronal view. (C,D) Postoperative 4 day, non-enhanced parenchymal peripheral wedge shaped lesion involving liver segment 2 and segment 5, which indicated hepatic infarction (arrowed). (E,F) After 4 month from cesarean section, hypotrophy of liver segment 2 and decreased size of infarcted area of liver showed.

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