A Case of Severe Pre‐Eclampsia Complicated by HELLP Syndrome and Extensive Hepatic Infarction

ABSTRACT Extensive hepatic infarction is a rare but potentially fatal complication of HELLP syndrome and is often difficult to recognize because of nonspecific clinical manifestations. A 34‐year‐old woman developed HELLP syndrome shortly after cesarean delivery for severe pre‐eclampsia, presenting with oliguria, marked thrombocytopenia (50 × 10 9 /L), and rapidly rising transaminases (ALT 1077 U/L, AST 1280 U/L). Contrast‐enhanced computed tomography (CT) revealed extensive hepatic infarction. Laboratory findings demonstrated microangiopathic hemolysis, severe coagulopathy, and acute kidney injury. Transient elevation of the terminal complement complex C5b‐9 raised concern for atypical hemolytic uremic syndrome. The patient was treated with plasma exchange, corticosteroids, organ support, and individualized anticoagulation guided by bleeding risk assessment. Serial follow‐up demonstrated sustained hematologic, renal, and hepatic recovery, ultimately excluding atypical hemolytic uremic syndrome. This case highlights the importance of imaging‐guided diagnosis, dynamic laboratory evaluation, and individualized therapeutic decision‐making in HELLP syndrome complicated by severe hepatic injury.