Spontaneous liver rupture following SARS-CoV-2 infection in late pregnancy: A case report

Table 1 Comparison of hemolysis, elevated liver enzymes, and low platelet count syndrome, pre-eclampsia, spontaneous liver rupture in pregnancy and our case

	Hypertension	Hemolysis/changes in coagulation/endothelial lesions	Leu/Tc	Liver function tests	Symptomatics	Histology	Proteinuria/Creatinine
HELLP	Hypertension SBP ≥ 18, 6 kpa or DBP ≥ 11, 9 kpa	Hemolysis (2 of the criteria listed): Peripheral blood smear with schistocytes and echinocytes; SBR ≥ 20,52 μmol/L; Low SHP ≤ 2210,5 μmol/L or LDH ≥ 2 times higher than normal level; severe anemia without blood loss	Tc: < 100 × 109/L	Elevation of LFT: AST or ALT ≥ 2 times higher than the normal level	Severe pain in the right upper abdominal quadrant; headache; nausea and vomiting; swelling of the extremities	Placental: Small placenta to gestational age, decidual vasculopathy, infarcts in the central portion, retroplacental hematoma, intravillous thrombosis; hepatic: Periportal hepatocellular necrosis, sharply demarcated hemorrhage with extended fibrin distribution from surrounding liver parenchyma, leukostasis in hepatic sinusoids	Proteinuria
PRE-ECLAMPSIA mild form	Hypertension SBP ≥ 18, 6 kpa or DBP ≥ 11, 9 kpa, measured on at least two occasions 4 h apart in previously normotensive women	NS	NS	NS	NS	NS	Proteinuria: ≥ 0, 3 g / 24 h, but < 5 g/24 h
PRE-ECLAMPSIASevere form	Hypertension: SBP ≥ 21, 3 kpa or DBP ≥ 14, 6 kpa, measured on at least two occasions 4 h apart	Schistocytes on peripheral blood smear; DIC	Tc: < 100 × 109/L	Elevation of LFT	Severe pain in the right or middle epigastrium; newly developed cerebral/visual symptoms; pulmonary oedema	Placental: No significant differences from HELLP	Scr > 97.262 µmol/L or doubling of scr level in the absence of other kidney disease
Spontaneous liver rupture in pregnancy	NS	Endothelial dysfunction; fibrin thrombus production	NS	Elevation of LFT	Abdominal pain; nausea; vomiting	NS	NS
Patient	Normotension	Negative schistocytes on peripheral smear	Leu: 13 × 109/L; Tc in normal range	SBR in normal range; LDH in normal range; ALT: 272,4 IU/L; AST: 159 IU/L; ALP: 172,8 IU/L	Epigastric and right hypochondrium pain	Hepatic: With foci of hemorrhage and necrosis centrilobularly; placental: Without signs of uterine vasculopathy	Sflt-1/plgf = 151

sFlt-1/PlGF Normal range < 38. NS: Non-specific; SBP/DBP: Systolic/diastolic blood pressure; HELLP: Hemolysis, elevated liver enzymes, and low platelet count syndrome; Leu: Leukocytes; Tc: Thrombocytes; LDH: Lactate dehydrogenase; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; LFT: Liver function tests; SHP: Serum haptoglobin; SBR: Serum bilirubin; SCr: Serum creatinine; sFlt-1: Soluble fms-like tyrosine kinase-1; PIGF: Placental growth factor; DIC: Disseminated intravascular coagulation.