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Rare cause of abdominal pain and fever in a pregnant woman
  1. Sophie Hillaire1,
  2. Jean-Emmanuel Kahn1,
  3. Olivier Picone2,
  4. Dominique Cazals-Hatem3
  1. 1Service de Médecine Interne, Hôpital Foch, Suresnes, France
  2. 2Service de Gynécologie-Obstétrique, Hôpital Foch, Suresnes, France
  3. 3Service d'Anatomo-Pathologie, Hôpital Beaujon, Clichy, France
  1. Correspondence to Dr Sophie Hillaire, Service de Médecine Interne, Hôpital Foch, 40 rue Worth, 92150 Suresnes, France; s.hillaire{at}hopital-foch.org

Abstract

Clinical presentation A pregnant woman (third trimester) presented with intense abdominal pain, nausea and myalgia. The patient was obese (body mass index 38) and was being treated for high blood pressure, hyperuricemia and hypothyroidism. She had chronic renal deficiency related to focal segmental glomerular sclerosis requiring dialysis. The physical examination at admission revealed a fever of 39°C and an acute abdomen with abdominal guarding in the right upper quadrant without hepatomegaly or splenomegaly. There were no clinical signs of pre-eclampsia. Fetal ultrasound and a Doppler of the umbilical vessels were normal. Laboratory tests showed normal liver and liver function (total protein 95%, alanine transaminase (ALT), aspartate transaminase (AST), total bilirubin normal). The white cell count was 10×109/l (90% neutrophils), with a normal platelet count. Blood, urine and vaginal cultures were negative. Abdominal ultrasound revealed isolated thickening of the gallbladder wall without cholelithiasis. Empirical antibiotic treatment was begun with intravenous amoxicillin. Six days later, the patient's condition had worsened with increased abdominal pain, persistent fever and liver test abnormalities (AST–ALT 6N). However, bilirubin, hepatic synthesis tests, as well as leucocyte and platelet counts were still normal. A caesarean section followed by coelioscopy was decided. Coelioscopy revealed a liver with numerous necrotic spots (see figure 1).

Figure 1

Diagnostic laparoscopy revealed a liver surface covered with numerous white necrotic spots.

Question What is the diagnosis?

  • ABDOMINAL PAIN
  • SEPSIS
  • LIVER DISEASE IN PREGNANCY

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Footnotes

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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