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Am J Perinatol. 2010 Feb;27(2):171-2. doi: 10.1055/s-0029-1234035. Epub 2009 Jul 22.

Malaria in pregnant woman masquerading as HELLP syndrome.

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Department of Obstetrics and Gynecology, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, 100, Boulevard du Général Leclerc, 92110 Clichy, France.


Malaria may be complicated by development of thrombocytopenia, elevated liver enzymes, and/or hemolysis, which may be difficult to distinguish from HELLP (hemolytic anemia; elevated liver enzymes; low platelet count) syndrome in a pregnant patient. A 33-year-old woman developed a HELLP-like syndrome and persistent fever postpartum without symptoms of preeclampsia. A malaria blood smear was performed and was positive for Plasmodium falciparum. The patient was immediately treated with quinine. The follow-up was uneventful with total disappearance of fever and prompt resolution of biochemical signs of HELLP-like syndrome 3 days later. Malaria in a pregnant woman can masquerade as HELLP syndrome. The wide overlap in symptoms (headache, malaise, digestive symptoms) does not suggest that symptoms would be effective in differentiating malaria and preeclampsia. A recent travel in endemic area, associated with malaria blood smear and clinic examination, should be the key of the differential diagnosis.

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