From the Division of Rheumatology, Department of Medicine, The Johns Hopkins University, Baltimore, Md.
Grand Rounds at The Johns Hopkins Hospital section editors: David
B. Hellmann, MD, D. William Schlott, MD, Stephen D. Sisson, MD, The Johns
Hopkins Hospital, Baltimore, Md; Edie Stern, managing editor, The Johns Hopkins
Hospital; David S. Cooper, MD, Contributing Editor, JAMA.
DR STONE: Mrs N is a 32-year-old businesswoman
from California. I became familiar with her case 2½ years ago when I was a postdoctoral fellow at the University of California,
San Francisco, and she presented to her local physician with right-upper–quadrant
pain. She has graciously agreed to join us at Hopkins today for Grand Rounds.
Mrs N, was the right-upper–quadrant pain the first symptom of
PATIENT: No. For 2 or 3 weeks before that,
I had noticed some swelling around my eyes and over my brow bone. My eyes
looked puffy. On Friday, the day before the pain started, my husband and I
went away for the weekend. During the 2-hour drive, I realized that my ankles
were swollen. To relieve the swelling, I put my feet up on the dashboard of
the car. After about 30 minutes, the definition of my ankles had returned
but my knees and upper legs had become very swollen. They stayed swollen for
the rest of the weekend.
Stone JH. HELLP Syndrome: Hemolysis, Elevated Liver Enzymes, and Low Platelets. JAMA. 1998;280(6):559-562. doi:10.1001/jama.280.6.559