A rare presentation of endogenous human chorionic gonadotrop
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Ovarian hyperstimulation syndrome is usually an iatrogenic and potentially life-threatening disease. It develops following ovulation induction and use of in vitro fertilization techniques.

A 32-year-old primigravida Ethiopian woman presented at 15 weeks of gestation with a history of progressive bilateral leg swelling and abdominal pain that started 2 weeks back. A week after her initial presentation, she experienced cough and shortness of breath, which continued for a week. She had no history of weight loss. Her pregnancy was conceived by IVF, and it was a triplet pregnancy. She didn’t have similar complaint on early follow-up during and after IVF. She was risk stratified with meticulous evaluation after embryo transfer and had follow-up evaluations every 15 days. She had history of treatment for pulmonary tuberculosis (TB) a year back, and she was declared cured at that time. She had no history of cardiovascular disease, nor kidney disease.

At presentation, she had distended abdomen with bilateral lower abdominal tenderness. Pelvic ultrasound was done and revealed bilateral polycystic enlarged ovaries measuring right ovary 12 × 11 cm and left ovary 11 × 13 cm. The pregnancy was viable-fetal heart beat was positive for fetuses. She had also ascites up to Morrison’s pouch. A conclusive diagnosis of OHSS was made, and she was admitted for conservative management.

Chest X-ray was done and showed miliary-pattern infiltrates bilaterally. Her erythrocyte sedimentation rate (ESR), complete blood count (CBC) profile, liver function test, renal function test, and coagulation profile, all were normal. Few days after admission, her shortness of breath worsened. Upon physical examination, she was in severe respiratory distress. Her oxygen saturation was 70%. She had tachycardia of 120 beats per minute and tachypnea of 50 breaths per minute. Her blood pressure was 120/100 mmHg.

With a revised diagnosis of severe OHSS with acute respiratory distress syndrome to rule out miliary tuberculosis, she was transfered to intensive care unit (ICU) and was put on mechanical ventilator. She was provided 80 mg of Lasix intravenous stat. She was provided crystalloids—3 Liters of normal saline. She was also started on anti-TB empirically, with additional diagnosis of disseminated TB. GeneXpert xpert test was negative. Bedside echocardiography was also done and was interpreted as normal.

Thyroid function test was not updated. Later on, a diagnosis of severe hospital-acquired infection-sepsis was made as patient's condition deteriorated. After 2 weeks of stay in ICU, she sadly passed away—she succumbed to refractory septic shock due to the severe hospital aquired infection.

Source: https://jmedicalcasereports.biomedcentral.com/articles/10.1186/s13256-021-02936-w
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