Recovery of both platelet and liver abnormalities from HELLP is usually rapid and complete, thus the case is surprising. Severe preeclampsia with HELLP has however, been rarely associated with liver infarction, and necrosis, that conceivably would lead to scarring. In addition, acute fatty liver of pregnancy can have HELLP like features, and histologic lesions resembling hepatitis have been described in that disorder. Also, the history of itching for six weeks before developing a preeclampsia-HELLP syndrome suggests the patient may have had another disease such as Ã¢â‚¬Å“benign cholestasis of pregnancyÃ¢â‚¬Â (usually itching with but mild enzyme elevations, but it can be associated with jaundice and more severe enzyme abnormalities). This is a disease of late pregnancy. This disease, too, abates postpartum, but may be associated with gall stones. Of importance here, is that if laboratory abnormalities persist the patient might be managed by a competent gastroenterologist, preferably one with experience in hepatic diseases, and if a liver biopsy was performed it might be read by a pathologist or hepatologist experienced in reading these biopsies. In sum, the case is very atypical, but it sounds like the patient is being followed closely by her physicians.
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