Abstract
Background Hepatic infarction is an exceedingly rare complication of hemolysis, elevated liver
enzymes, and low platelets syndrome. Few cases have been described in the medical
literature and the true incidence remains unknown. It can lead to fulminant liver
failure, liver transplant, or death if not promptly addressed.
Case Report A 22-year-old primigravida presented with right upper quadrant and epigastric pain
at 28 weeks' gestation. She had severely elevated blood pressures requiring intravenous
antihypertensives as well as proteinuria, thrombocytopenia, and mild transaminitis.
Within 6 hours of admission, her rapidly rising liver function tests (LFTs) necessitated
urgent delivery by primary cesarean section. Her liver enzymes continued to rapidly
worsen postoperatively and immediate postpartum computed tomography of the abdomen
and pelvis revealed massive hepatic infarction, 11 × 10 × 15 cm, of the right lobe
of the liver. Her transaminases peaked at alanine transferase of 2,863 IU/L and aspartate
transferase of 2,732 IU/L. She received supportive multidisciplinary intensive care,
and LFTs returned to normal by postoperative day 20.
Conclusion Hepatic infarction is an extraordinarily rare complication of pre-eclampsia. Early
recognition and prompt multidisciplinary management are vital to prevent catastrophic
bleeding, hepatic failure, and death.
Keywords
HELLP syndrome - pre-eclampsia - liver - infarction - preterm
