An Autopsy Case of Severe Ovarian Hyperstimulation Syndrome with Multifocal Arterial and Venous Thromboembolism

Korean J Leg Med. 2011 May;35(1):57-61. English.

Department of Pathology, Kyung Hee University Medical Center, Seoul, Korea

Division of Forensic Medicine, Central District Office National Forensic Service, Daejeon, Korea. lillu79@korea.kr

Division of Forensic Medicine, National Forensic Service, Seoul, Korea

Western District Office National Forensic Service, Jangsung, Korea

Ovarian hyperstimulation syndrome (OHSS) is a rare, serious complication of assisted reproductive procedures for fertility treatment. Although most cases of OHSS are mild to moderate in nature, its severe form causes life-threatening complications including respiratory distress, renal failure, liver dysfunction, and thromboembolism because of hemoconcentration. We herein report a rare autopsy case of severe OHSS in a 29-year-old woman who underwent controlled ovulation induction. Three days after the administration of human chorionic gonadotropin, she developed abdominal pain and distension. Two days after, she suddenly developed respiratory arrest, hypotension and semicomatose mentality and died of respiratory failure. At autopsy, multifocal thromboembolism was detected in the internal carotid arteries, internal jugular veins, pulmonary arteries, inferior vena cava, renal arteries, and deep leg veins. And there were cerebral edema, anasarca, pleural effusion, massive pulmonary edema, ascites, and bilateral ovarian enlargement. Microscopically, the bilateral ovaries showed multiple well-developed cyst formations consisting of membrane granulosa and theca interna. To the best of our knowledge, this is the first autopsy report of severe OHSS with multifocal arterial and venous thromboembolism.

Key words : ovarian hyperstimulation syndrome, thromboembolism, autopsy

Case report