A Case of Ectopic Pregnancy With an Unusually High Level of β-hCG Correlating With Normal Pregnancy

This case report demonstrates an uncommon presentation of ectopic pregnancy. Diagnosis is usually based on clinical findings, ultrasound imaging, and serial serum beta-human chorionic gonadotropin (β-hCG) levels. However, β-hCG levels alone cannot reliably determine the location of a pregnancy, and in some cases, values may mimic those of a viable intrauterine pregnancy. This case highlights the diagnostic challenges when clinical symptoms suggest ectopic pregnancy despite β-hCG levels appearing consistent with normal intrauterine gestation. We report the case of a 34-year-old woman at around six weeks of gestation who presented with sudden-onset right iliac fossa (RIF) pain. She denied vaginal bleeding and had not yet undergone an antenatal scan. Her past obstetric history patient includes one spontaneous miscarriage four months prior, with no other significant medical conditions. Her vital signs were normal and initial blood tests showed normal inflammatory markers and stable haemoglobin level. Serum β-hCG was 29,457 IU/L, which was correlating with her gestational age. Because of misleadingly high β-hCG levels and limited ultrasound availability over the weekend, other possible diagnoses, such as acute appendicitis or ruptured ovarian cyst, were initially considered. The patient underwent a transvaginal ultrasound (TVUSS) two days after admission, which confirmed an empty uterus and a left adnexal ectopic pregnancy with a fetal pole. This case demonstrates a challenging presentation of ectopic pregnancy. Therefore, clinicians must maintain a high index of suspicion for ectopic pregnancy, even when β-hCG level resemble normal ranges for intrauterine pregnancy. Early imaging review is critical to avoid diagnostic delay and improve maternal outcomes.