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Case Report
Isolated pleural effusion as sole presentation of Ovarian Hyperstimulation Syndrome
1 Resident, Pennsylvania Hospital, University of Pennsylvania Health System Department of Obstetrics and Gynecol, USA
2 Medical Director, Society Hill Reproductive Medicine, Philadelphia, PA, USA
Address correspondence to:
Jenna Lipson
MD, 800 Spruce Street, 2 Pine East Building, Philadelphia, Pennsylvania 19107,
USA
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Article ID: 100040Z08JL2018
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Lipson J, Kelly M. Isolated pleural effusion as sole presentation of Ovarian Hyperstimulation Syndrome. J Case Rep Images Obstet Gynecol 2018;4:100040Z08JL2018.ABSTRACT
Introduction: Isolated pleural effusion in severe OHSS is a rare occurrence and is typically associated with high peak estradiol. This case highlights that pleural effusion in setting of severe OHSS can occur in the absence of most of the recognized risk factors for OHSS, including in patients with a low estradiol. It is also the first case report of isolated pleural effusion in OHSS where a Cabergoline resuce protocol was used.
Case Report: A 32-year-old known to have Polycystic Ovarian Syndrome (PCOS) underwent Controlled Ovarian Stimulation with hCG trigger, followed by cryopreservation. Her Estradiol on day of hCG trigger was 1761 pg/ml. Due to her history of PCOS, she was started on Cabergoline for prevention of OHSS. On day 7 following hCG trigger, the patient noted new onset of gastroesophageal reflux which was progressive until presentation the emergency room on day 9 for chest pressure. Her abdominal exam was benign. Cardiac workup was negative. She was diagnosed with bilateral pleural effusions (R>L) by CT scan, thought to be secondary to OHSS. She underwent a right thoracentesis where a 450cc of pleural fluid was drained from the right hemithorax. Following the procedure, her symptoms resolved.
Conclusion: This report suggests that low/normal E2 is not protective against development of severe OHSS. Additionally, it suggests that the use of cabergoline in COS cycles may decrease the overall severity of OHSS in high risk patients.
Keywords: Cabergoline, Ovarian hyperstimulation syndrome, Pleural effusion, Severe OHSS
SUPPORTING INFORMATION
Author Contributions
Jenna Lipson - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Maureen Kelly - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementGiven this case report does not contain identifying information, informed consent was not obtained in accordance with the University of Pennsylvania IRB guidelines.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2018 Jenna Lipson et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
