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P11.12: A case of an unusual presentation of the ovarian hyperstimulation syndrome

Ovarian hyperstimulation syndrome (OHSS) is the most serious complication of in vitro fertilisation (IVF). While mild forms may resolve spontaneously, severe forms could result in fatal complications. The symptoms usually begin 4–5 days after oocyte collection. Patients may complain of pain, abdominal swelling, in severe cases abdominal pain, nausea, vomiting and signs of fluid accumulation in the chest with shortness of breath. Severe OHSS has been reported in 3–8% of IVF cycles. We report the case of OHSS presenting with massive pleural exudate. A 29 year-old patient treated for 5 years for primary infertility was admitted to our Department on the 14th day of stimulatory cycles after ovarian transfer. She presented with abdominal pain; her physical examination revealed enlarged ovaries, according to ultrasound examination the size was 8 cm in diameter on both sides and there was no ascites. Laboratory examination did not show any signs of hemoconcentration. Continuous infusion therapy led to progressive signs of OHSS – presenting with nausea, vomiting and abdominal pain. On the 17th day of the cycle the patient was transferred to the intensive care unit because of severe breath shortness, tachypnoea and a decrease in oxygen saturation to 75%. Ultrasound examination showed an increase in the size of ovaries to 14 cm in diameter but non-significant ascites. Surprisingly, advanced ultrasonography showed considerable pleural effusion. CT scan confirmed an extensive effusion with compressive atelectasis in the lower lobes and dorsal lung segments. Drainage of both pleural effusions gave 2.3 litres of fluid during the first 24 hours. Laboratory findings showed a decrease in total bilirubin in blood to 50 g/l and albumin to 27 g/l with normalisation within 2 days of plasma therapy. Pleural effusion vanished within the next 48 hours; afterwards patient recovered rapidly. Control ultrasound examination two weeks later showed neither ascites nor pleural effusion.