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Fever, cough and gastrointestinal symptoms in a pregnant woman

Nivedita Jha, Divya M Balachandran and Ajay K Jha
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DOI: https://doi.org/10.7861/clinmed.2021-0443
Clin Med September 2021
Nivedita Jha
AJawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
Roles: assistant professor
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Divya M Balachandran
BJawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
Roles: senior resident
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Ajay K Jha
CJawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
Roles: associate professor
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  • For correspondence: drajaykjha@rediffmail.com
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    Fig 1.

    Postpartum imaging. a) Contrast-enhanced computed tomography ­suggesting hepatosplenomegaly. b) Positron emission tomography using F18 fluorodeoxyglucose showing no focal abnormal tracer uptake; bilateral lung and visualised bone marrow are unremarkable.

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    Fig 2.

    Timeline of changes in laboratory parameters from admission to discharge and follow-up at the end of 2 months (delivery was on day 3 of admission). TLC = total leukocyte count.

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    Table 1.

    Differential diagnosis of fever with gastrointestinal dysfunction during pregnancy

    HLH (in this patient)Acute fatty liverHELLP syndromeVisceral leishmaniasisMiliary/abdominal tuberculosisHaemolytic anaemiasChronic hepatitisLymphomas
    FeverYesYes, rarelyNoYesYesYes, infrequentYesYes
    Abdominal painYesYesYesYesYesYes, splenic infarctYesYes
    VomitingYesYesYesYesYesNoYesNo
    Neurological symptomsNoYesYesYes, rarelyYesYesYesNo
    SplenomegalyYesNoNoYesYesYesYesYes
    HepatomegalyYesNoNoYesYesNoNoYes
    Liver dysfunctionYesYesYesNoYes, anti-tubercular medicationsYesYesYes
    Coagulation abnormalitiesNoYesYesNoNoNoYesYes, in advanced stages
    AnaemiaYesYes, haemolysisYes, occa­sionallyYesYes, infrequentlyYesYesYes
    Thrombocy­topeniaYesYesYesYesYes, infrequentlyYesYesYes, rarely immune mediated
    LeukopeniaYesYes, leukocytosisNoNoYes, rarely, leukocytosis commonNoNoYes, leukocytosis more common than leukopenia
    High serum ferritinYesNoNoNoYes, rarelyYes, rarelyYes, only in advanced cirrhosisYes
    High serum triglycerideYesYes, infrequently, mainly hypercholes­terolemiaNoNoYes, extremely rareNoYes, infrequentlyYes, rarely
    Low serum fibrinogenYesYesYesNoYes, rarelyNoYesYes, advanced stages
    • HLH = haemophagocytic lymphohistiocytosis; HELLP = haemolysis, elevated liver enzymes and low platelets

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Fever, cough and gastrointestinal symptoms in a pregnant woman
Nivedita Jha, Divya M Balachandran, Ajay K Jha
Clinical Medicine Sep 2021, 21 (5) e526-e528; DOI: 10.7861/clinmed.2021-0443

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Fever, cough and gastrointestinal symptoms in a pregnant woman
Nivedita Jha, Divya M Balachandran, Ajay K Jha
Clinical Medicine Sep 2021, 21 (5) e526-e528; DOI: 10.7861/clinmed.2021-0443
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