Severe pre-eclampsia complicated by acute fatty liver disease of pregnancy, HELLP syndrome and acute kidney injury following SARS-CoV-2 infection

BMJ Case Rep. 2020 Aug 11;13(8):e237521. doi: 10.1136/bcr-2020-237521.

Abstract

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has presented many diagnostic challenges and uncertainties. Little is known about common pathologies complicating pregnancy and how their behaviour is modified by the presence of SARS-CoV-2. Pregnancy itself can alter the body's response to viral infection, which can cause more severe symptoms. We report the first case of a patient affected with sudden-onset severe pre-eclampsia complicated by acute fatty liver disease of pregnancy, HELLP (haemolysis, elevated liver enzymes and low platelet) syndrome and acute kidney injury following SARS-CoV-2 infection. Although an initial diagnostic dilemma, a multidisciplinary team approach was required to ensure a favourable outcome for both the mother and the baby. Our case report highlights the need for health professionals caring for pregnant women to be aware of the complex interplay between SARS-CoV-2 infection and hypertensive disorders of pregnancy.

Keywords: haematology (incl blood transfusion); hypertension; liver disease; obstetrics and gynaecology; pregnancy.

Publication types

  • Case Reports

MeSH terms

  • Acute Kidney Injury / blood
  • Acute Kidney Injury / complications*
  • Acute Kidney Injury / diagnosis
  • Adult
  • Betacoronavirus*
  • COVID-19
  • Coronavirus Infections / blood
  • Coronavirus Infections / complications*
  • Fatty Liver / blood
  • Fatty Liver / complications*
  • Fatty Liver / diagnosis
  • Female
  • HELLP Syndrome / blood
  • HELLP Syndrome / diagnosis*
  • Humans
  • Kidney Function Tests
  • Pandemics
  • Pneumonia, Viral / blood
  • Pneumonia, Viral / complications*
  • Pre-Eclampsia / blood
  • Pre-Eclampsia / diagnosis*
  • Pregnancy
  • Pregnancy Complications / blood
  • Pregnancy Complications / diagnosis
  • Pregnancy Complications, Infectious / blood
  • Pregnancy Complications, Infectious / diagnosis*
  • SARS-CoV-2

Supplementary concepts

  • Acute fatty liver of pregnancy