An autopsy case of ovarian hyperstimulation syndrome with massive pulmonary edema and pleural effusion

Ovarian hyperstimulation syndrome (OHSS) is the most serious complication o f ovulation induction with exogenous gonadotropins, such as human menopausa l gonadotropin and follicle-stimulating hormone. These hormones are conside red to increase capillary permeability and cause third space fluid shift. W e report an autopsy case of severe OHSS in a 28-year-old Japanese female. T he patient developed bilateral chest pain and progressive dyspnea during th e course of administration of human gonadotropins. Pleural effusion and hyp ouresis clinically disappeared 4 days after the onset of the symptoms, but the patient died suddenly of rapid respiratory insufficiency. Autopsy exami nation revealed massive pulmonary edema, intra-alveolar hemorrhage and pleu ral effusion without any evidence of pulmonary thromboembolism. Histopathol ogical examination of the ovary demonstrated multiple well-developed follic le formations, consistent with OHSS. It is very important to recognize that massive pulmonary edema can occur in a patient with OHSS. To the best of o ur knowledge, this is the first autopsy report of a patient with severe OHS S.