Pregnancy-Induced Hemophagocytic Lymphohistiocytosis: A Case Report
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CASE REPORT
Pregnancy‑Induced Hemophagocytic Lymphohistiocytosis: A Case Report Luis A. Sánchez‑Ato1 · Flavia A. Cuestas‑Quiroz1 · Carla Agurto‑Saldaña2 · David Estela‑Ayamamani1,2 Received: 23 June 2019 / Accepted: 28 September 2019 © Federation of Obstetric & Gynecological Societies of India 2019
Case Report We present a 23-year-old pregnant woman gravida 3, para 1 27 weeks of gestation complaining of intermittent fever, hyporexia, and vomiting since one week. She had history of malar rash that increased with sun exposure since adolescence. Physical examination revealed fever, pulse of 99 beats per min, blood pressure of 80/50 mmHg, and breathing frequency of 19/min. She was pale, a maculopapular skin rash over both cheeks was observed. There was no lymphadenopathy or joint pain. The liver was palpable 2 cm below the right costal margin and tender; the spleen was not palpable. The uterus was gravid, normal tone, fetal heart rate was 158 beats per min, fetal movement was present, and uterine height was 23 cm. She was awake, oriented, and responsive. Laboratory results showed a hemoglobin of 11.1 g/dL, leukocytes of 6220/mm3, a platelet count of 240,000/mm3, and C protein reactive of 13.3 mg/L, urinary sediment showed leukocyturia without nitrites. Luis A. Sánchez-Ato ia an assistant professor, Escuela de Medicina, Facultad de Ciencias de la Salud, Universidad Peruana de Ciencias Aplicadas (UPC), Lima, Peru; Flavia A. Cuestas‑Quiroz ia an assistant professor Escuela de Medicina, Facultad de Ciencias de la Salud, Universidad Peruana de Ciencias Aplicadas (UPC), Lima, Peru; Carla Agurto‑Saldana is a Gynecologist, Departamento de Obstetricia y Ginecología, Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru; David Estela‑Ayamamani is a Gynecologist, Escuela de Medicina, Facultad de Ciencias de la Salud, Universidad Peruana de Ciencias Aplicadas (UPC), Lima, Peru and Departamento de Obstetricia y Ginecología, Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru. * Luis A. Sánchez‑Ato [email protected] 1
Escuela de Medicina, Facultad de Ciencias de la Salud, Universidad Peruana de Ciencias Aplicadas (UPC), Lima, Peru
Departamento de Obstetricia y Ginecología, Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru
2
There was a suspicion of urinary tract infection; therefore, urinary and blood culture (both negative) were performed, and empiric antibiotic treatment was started using ceftriaxone. TORCH, HTLV I-II, and EBV serology tests were negative. An autoimmune disease was ruled out with negative ANA, anticardiolipin, ANCA MPO, and ANCA PR3. Tumor screening was negative according to abdominal CT, AFP, CEA, CA19-9, and CA-125. The patient presented with acute respiratory distress and was transferred to intensive care unit, with the chest skiagram showing diffuse infiltrates in both lung fields (Fig. 1). New laboratory test was performed 16 days after the admission, which was suggestive of hemoglobin 5.3 mg/dL, total leukocyte count 2240/ mm3, and platelets 38,000/mm3. Renal function rev
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