Thrombotic microangiopathy complicate with the severe sudden-onset liver ruptures in a pre-eclampsia patient after the caesarean section: a case report

Background The sudden-onset life-threatening liver rupture is a rare complication of pregnancy-associated thrombotic microangiopathy. Patients with both HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome and atypical haemolytic uraemic syndrome (aHUS) are very rare, who are always in a significantly urgent situation and hard to treat. We herein report a case of successfully treating a patient who experienced a severe liver rupture with HELLP syndrome and aHUS after the caesarean section. Case presentation: A 37-year-old woman had a sudden-onset hypertension and proteinuria; thus, she was diagnosed as pre-eclampsia and then a caesarean section was performed. After that, she had the continuous hemolysis, significantly elevated liver enzymes and low platelet count with oliguria and increased creatinine. During the treatment, we organized the multi-disciplinary treatment twice to make decisions of an intervention and an exploratory laparotomy. Combined with the other active treatment, blood transfusion, plasma exchange, and continuous renal replacement therapy, the patient finally survived and returned to a healthy state. Conclusions Physicians should pay special attention to the possibility of a severe liver rupture in pre-eclampsia and thrombotic microangiopathy patients during pregnancy or post-partum. The active life support and the good multi-disciplinary treatment help a lot for survival.