A Case of Severe Pre-Eclampsia Complicated by HELLP Syndrome and Extensive Hepatic Infarction

Extensive hepatic infarction is a rare but potentially fatal complication of HELLP syndrome and is often difficult to recognize because of nonspecific clinical manifestations. A 34-year-old woman developed HELLP syndrome shortly after cesarean delivery for severe pre-eclampsia, presenting with oliguria, marked thrombocytopenia (50 × 10⁹/L), and rapidly rising transaminases (ALT 1077 U/L, AST 1280 U/L). Contrast-enhanced computed tomography (CT) revealed extensive hepatic infarction. Laboratory findings demonstrated microangiopathic hemolysis, severe coagulopathy, and acute kidney injury. Transient elevation of the terminal complement complex C5b-9 raised concern for atypical hemolytic uremic syndrome. The patient was treated with plasma exchange, corticosteroids, organ support, and individualized anticoagulation guided by bleeding risk assessment. Serial follow-up demonstrated sustained hematologic, renal, and hepatic recovery, ultimately excluding atypical hemolytic uremic syndrome. This case highlights the importance of imaging-guided diagnosis, dynamic laboratory evaluation, and individualized therapeutic decision-making in HELLP syndrome complicated by severe hepatic injury.