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Massive vulvar edema in ovarian hyperstimulation syndrome. A case report
M E Coccia1, G L Bracco, A Cattaneo
1Institute of Gynecology and Obstetrics II, University of Florence, Italy.
Background:
Bilateral vulvar edema associated with severe ovarian hyperstimulation syndrome is described for the first time.
Case:
A 28-year-old woman underwent gonadotropin-releasing hormone analogue and gonadotropin treatment for in vitro fertilization and embryo transfer. On day 18 of the cycle, the patient reported mild abdominal discomfort that became severe during the following four days. One the 22nd day of the cycle, bilateral ovarian enlargement and ascites were present. The vulva showed massive edema and fissures. Ovarian hyperstimulation syndrome (OHSS) therapy consisted of human albumin, lactated Ringer's solution and heparin. The vulvar edema was treated with topical hydrocortisone ointment, ice packs and topical gentamycin twice a day. After one week of treatment, the vulva was normal.
Conclusion:
We think that the vulvar edema in this case was the result of decreased oncotic pressure and increased hydrostatic pressure, as occur during OHSS.