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ACCP-SEEK Board Review Question of the Month |

A 32-Year-Old Pregnant Woman With Malaise, Headache, Nausea, Right Upper Quadrant Abdominal Pain, and Facial Swelling

Stephanie Levine, MD, FCCP
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From the ACCP-SEEK program, reprinted with permission. Items are selected by Department Editors Richard S. Irwin, MD, FCCP, and John G. Weg, MD, FCCP. For additional information about the ACCP-SEEK program, phone 1-847-498-1400.



Chest. 1999;115(6):1729-1730. doi:10.1378/chest.115.6.1729
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A 32-year-old woman in her 36th week of pregnancy is admitted to your ICU after presenting with complaints of malaise, headache, nausea, right upper quadrant abdominal pain, and facial swelling. She denies alcohol abuse, fevers, chills, and hepatitis exposure. She is not on any medication at home. She is alert and oriented. Blood pressure is 160/98 mm Hg, pulse is 100 beats/min, respirations are 20 breaths/min and unlabored, and temperature is 37.2°C. Sclerae reveal mild icterus, and there is mild facial edema. Lung examination is normal. The abdomen is consistent with a gravid uterus; it is soft and nontender and bowel sounds are decreased. Fetal heart tones are normal and regular. There is diffuse, 2+ pitting edema. Neurologic examination is nonfocal. Laboratory tests are notable for a hematocrit of 32% and WBC count of 8,400/mm3 (8.4 × 109/L) with a normal differential. Platelet count is 85,000/mm3 (85 × 109/L). Prothrombin time is 13 s, and partial thromboplastin time is 41 s. Glucose and electrolytes are within normal limits. Creatinine is 1.4 mg/dL (124μ mol/L), and BUN is 25 mg/dL (8.9 mmol/L). Liver function tests reveal an alanine aminotransferase of 100 IU/L, an aspartate aminotransferase of 95 IU/L, a bilirubin of 3.2 mg/dL (55 μmol/L), and lactate dehydrogenase of 820 IU/L. Urinalysis shows 2+ protein. The peripheral blood smear is shown (Fig 1). Which of the following diagnoses most likely accounts for the patient’s findings?

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