Hyperreactio Luteinalis with early-onset HELLP syndrome: A case report

Introduction: Hyperreactio Luteinalis (HL) is a rare benign condition in pregnancy which is characterized by bilaterally multicystic ovarian enlargement containing theca lutein cysts caused by increased production of hCG. HL is mostly associated with hydatidiform mole and multiple pregnancies. Case Report: We report a unique case of hyperreactio Luteinalis (HL) in spontaneous singleton pregnancy with elevated level of human chorionic gonadotropin (hCG) and alpha-fetoprotein (AFP) for who referred to our center for high blood pressure and proteinuria which subsequently developed early–onset HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count) at 18 weeks of pregnancy. Termination of pregnancy was considered and a patient passed a normal dead fetus. Placental histology showed evidence of hypoperfusion with focal villous infarction and ischemic changes without evidence of trophoblastic abnormalities. Conclusion: Hyperreactio luteinalis associating with high level of hCG in second trimester can be consequence of inadequate trophoblast invasion and may be a risk factor for early onset HELLP syndrome.