Fever, cough and gastrointestinal symptoms in a pregnant woman

Abstract

Despite distinct diagnostic criteria, several gastrointestinal pathologies can masquerade haemophagocytic lymphohistiocytosis (HLH) during the peripartum period. Acute fatty liver of pregnancy, HELLP (haemolysis, elevated liver enzymes and low platelets) syndrome, miliary tuberculosis, visceral leishmaniasis, abdominal surgical emergencies, haemolytic anaemias and haematological malignancies may have clinical and laboratory presentation similar to that of HLH. In this report, we present the case of a 26-year-old woman with 38-weeks' gestation and abdominal pain, vomiting, intermittent fever and non-productive cough for 1-2 months. A thorough investigation suggested HLH and the patient was successfully treated with corticosteroids. This patient demonstrates the importance of a focused investigation strategy and timely management to prevent mortality and morbidity to both the mother and fetus in this rare and fatal disease.

Keywords: corticosteroids; fever; haemophagocytic lymphohistiocytosis; pregnancy.

Fig 1.

Postpartum imaging. a) Contrast-enhanced computed tomography ­suggesting hepatosplenomegaly. b) Positron emission tomography using F18 fluorodeoxyglucose showing no focal abnormal tracer uptake; bilateral lung and visualised bone marrow are unremarkable.

Fig 2.

Timeline of changes in laboratory parameters from admission to discharge and follow-up at the end of 2 months (delivery was on day 3 of admission). TLC = total leukocyte count.