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Causes of Massive Vulvar Edema in Patients with Severe Ovarian Hyperstimulation Syndrome: A Case Report and Literature Review

Unusual clinical course, Challenging differential diagnosis, Unusual or unexpected effect of treatment, Clinical situation which can not be reproduced for ethical reasons

Vilma Kovač, Milan Reljič, Tina Bizjak

Slovenia Department of Reproductive Medicine and Gynecological Endocrinology, University Medical Centre Maribor, Maribor, Slovenia

Am J Case Rep 2019; 20:238-241

DOI: 10.12659/AJCR.913149

Available online: 2019-02-23

Published: 2019-02-23


BACKGROUND: Ovarian hyperstimulation syndrome (OHSS) is a potentially serious complication of ovulation stimulation. Modest vulvar edema is frequently seen in a severe form of OHSS; however, cases of massive bilateral vulvar edema are rare and pathogenesis is uncertain.
CASE REPORT: We report a 31-year-old patient with massive vulvar edema and severe OHSS after IVF treatment with GnRH antagonist and gonadotropins. Five days after embryo transfer, she was hospitalized because of severe clinical manifestation of OHSS and on the fifth day after admission she developed a massive bilateral vulvar edema. After conventional medical therapy of OHSS, vulvar edema spontaneously resolved.
CONCLUSIONS: Hypoproteinemia with low oncotic pressure and certain personal tissue characteristics may play the main role in the pathogenesis of massive vulvar edema in OHSS.

Keywords: Ovarian Hyperstimulation Syndrome, Pregnancy Complications, Vulva