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

Hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome is often associated with preeclampsia or hypertension in pregnancy. Pregnancy in patients with systemic lupus erythematosus (SLE) may be complicated by development of a lupus flare with thrombocytopenia, hypertension and renal insufficiency, which may be difficult to distinguish from preeclampsia. We describe a 20-year-old patient with SLE and anticardiolipin antibodies who developed a HELLP-like syndrome during 2 successive pregnancies without the more typical symptoms of preeclampsia or hypertension. This unusual presentation of HELLP syndrome during pregnancy in a patient with SLE was evidenced by hematologic and liver enzyme abnormalities as a sign of ongoing hepatic necrosis. Early recognition of this syndrome is important because it may result in rapid deterioration with progressive hepatic necrosis that can be reversible with early termination of pregnancy.