HELLP-like syndrome associated with hepatic necrosis in a patient with systemic lupus erythematosus

Hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome is oft en associated with preeclampsia or hypertension in pregnancy. Pregnancy in patients with systemic lupus erythematosus (SLE) may be complicated by deve lopment of a lupus flare with thrombocytopenia, hypertension and renal insu fficiency, which may be difficult to distinguish from preeclampsia. We desc ribe a 20-year-old patient with SLE and anticardiolipin antibodies who deve loped a HELLP-like syndrome during 2 successive pregnancies without the mor e typical symptoms of preeclampsia or hypertension. This unusual presentati on of HELLP syndrome during pregnancy in a patient with SLE was evidenced b y hematologic and Liver enzyme abnormalities as a sign of ongoing hepatic n ecrosis. Early recognition of this syndrome is important because it may res ult in rapid deterioration with progressive hepatic necrosis that can be re versible with early termination of pregnancy.