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Reply: Postpartum high fever and imitators of HELLP syndrome
American Journal of Emergency Medicine xxx (2016) xxx–xxx
Contents lists available at ScienceDirect
American Journal of Emergency Medicine journal homepage: www.elsevier.com/locate/ajem
Correspondence
Reply: Postpartum high fever and imitators of HELLP syndrome To the Editor, I would like to thank the readers for their comments on our case report. I completely agree with their conclusion. There actually exist many imitators of HELLP syndrome in clinical practice that we should consider differential diagnoses. However, the mechanism of HELLP syndrome, in which vascular endothelial disorder is considered to be main condition, has not been well clarified, and the current criteria of HELLP syndrome include a lot of other diseases. We should seek more detailed criteria for diagnosing HELLP syndrome in the future. Meanwhile, there exist many cases in whom symptoms or clinical course is not typical, however, the diagnosis could be nothing but HELLP syndrome. There are cases in which a differential diagnosis could not be made, even with detailed and adequate examination, such as our case. Although some of these cases are the imitators of
HELLP syndrome, they consist of atypical but true HELLP syndrome. If vascular endothelial disorder is essential to the diagnosis, a high fever should be present. I think that some categorization needed in the criteria of HELLP syndrome. Unfortunately that blood examination was not performed until she was discharged 5 days after delivery.
Kensuke Nakamura MD PhD Department of Emergency and Critical Care Medicine, Hitachi General Hospital, 2-1-1, Jonantyo, Hitachi, Ibaraki, 317-0077, Japan Tel.: +81 294 23 1111; fax: +81 294 23 8317 E-mail address: [email protected] http://dx.doi.org/10.1016/j.ajem.2016.08.021
0735-6757/© 2016 Elsevier Inc. All rights reserved.
Please cite this article as: Nakamura K, Reply: Postpartum high fever and imitators of HELLP syndrome, Am J Emerg Med (2016), http://dx.doi.org/ 10.1016/j.ajem.2016.08.021
Contents lists available at ScienceDirect
American Journal of Emergency Medicine journal homepage: www.elsevier.com/locate/ajem
Correspondence
Reply: Postpartum high fever and imitators of HELLP syndrome To the Editor, I would like to thank the readers for their comments on our case report. I completely agree with their conclusion. There actually exist many imitators of HELLP syndrome in clinical practice that we should consider differential diagnoses. However, the mechanism of HELLP syndrome, in which vascular endothelial disorder is considered to be main condition, has not been well clarified, and the current criteria of HELLP syndrome include a lot of other diseases. We should seek more detailed criteria for diagnosing HELLP syndrome in the future. Meanwhile, there exist many cases in whom symptoms or clinical course is not typical, however, the diagnosis could be nothing but HELLP syndrome. There are cases in which a differential diagnosis could not be made, even with detailed and adequate examination, such as our case. Although some of these cases are the imitators of
HELLP syndrome, they consist of atypical but true HELLP syndrome. If vascular endothelial disorder is essential to the diagnosis, a high fever should be present. I think that some categorization needed in the criteria of HELLP syndrome. Unfortunately that blood examination was not performed until she was discharged 5 days after delivery.
Kensuke Nakamura MD PhD Department of Emergency and Critical Care Medicine, Hitachi General Hospital, 2-1-1, Jonantyo, Hitachi, Ibaraki, 317-0077, Japan Tel.: +81 294 23 1111; fax: +81 294 23 8317 E-mail address: [email protected] http://dx.doi.org/10.1016/j.ajem.2016.08.021
0735-6757/© 2016 Elsevier Inc. All rights reserved.
Please cite this article as: Nakamura K, Reply: Postpartum high fever and imitators of HELLP syndrome, Am J Emerg Med (2016), http://dx.doi.org/ 10.1016/j.ajem.2016.08.021