CASE REPORT Hyperreactio Luteinalis, A Great Imitator on Ultrasound: Is There a Relation with HELLP Syndrome? Ahmed Samy El-Agwany 1 • El-Sayed El-Badawy Awad 1 Received: 1 January 2016 / Revised: 31 January 2016 / Accepted: 17 February 2016 Ó Association of Gynecologic Oncologists of India 2016 Abstract Introduction Hyperreactio luteinalis (HL) is a rare benign condition that is characterized by multicystic and bilateral ovarian enlargement in pregnancy and regression after delivery caused by increased production or increased sen- sitivity of human chorionic gonadotropin (HCG). Case Report We report a case of HL in pregnancy and subsequently developing of HELLP syndrome. A 30-year- old multigravida diagnosed at 11 weeks of pregnancy of HL and subsequently developed HELLP syndrome. Cesarean section (CS) due to the developing of HELLP syndrome was done (failed induction of labor). In first trimester, our patient had symptoms of abdominal pain. Both ovaries were enlarged and multicystic on ultrasound. Hormonal studies confirmed abnormally elevated level of B-HCG (300,000 IU/L). At 30 weeks of pregnancy, severe preeclampsia and HELLP syndrome occurred. Emergency CS was preformed, and she delivered a male newborn. One week after delivery blood pressure and abnormal hormonal status returned to normal. Conclusion For obstetricians, it is important to be aware of HL, which is benign and self-imitated, and to differen- tiate it from malignant ovarian tumors in pregnancy and OHSS. Hyperreactio luteinalis with high level of HCG in first trimester could be a consequence of inappropriate trophoblast invasion, and early sign of subsequently developing preeclampsia, eclampsia or HELLP syndrome. Keywords Hyperreactio luteinalis Á Elevated HCG Á Trophoblast invasion Á Eclampsia Á HELLP syndrome Introduction Hyperreactio luteinalis (HL) is a rare benign condition that is characterized by multicystic and bilateral ovarian enlargement in pregnancy and regression after delivery caused by increased production or increased sensitivity of human chorionic gonadotropin (HCG) [1]. Only 30 cases associated with normal singleton pregnancies are reported in the literature, and most of them were discovered in last trimester of pregnancy [2]. Majority are asymptomatic, and enlarged ovaries are usually accidentally discovered at routine ultrasound examination. This benign condition may imitate ovarian hyperstimulation syndrome (OHSS) and ovarian malignancy. OHSS is usually consequence of iatrogenic ovarian induction, but in the rare occasions it can occur spontaneously, particularly in hypothyroidism, polycystic ovarian syndrome (PCOS), or mutation in FSH/ LH receptors [3]. Proper diagnosis of HL with high B-HCG and bilateral multicystic ovary on ultrasound with no history of ovula- tion induction or solid areas on ultrasound avoid surgical intervention or termination of pregnancy [4]. Symptomatic pregnant women may complain of abdominal pain of dis- tension or undergo ovarian torsion and in some cases associated with hyperemesis gravidarum, hyperthyroidism, hyperandrogenism, intrauterine growth restriction (IUGR) and eclampsia [5–8]. We present a unique case of HL diagnosed in early pregnancy and subsequently developed hemolysis, elevated liver enzymes and low platelet (HELLP) syndrome. & Ahmed Samy El-Agwany Ahmedsamyagwany@gmail.com 1 Department of Obstetrics and Gynecology, Faculty of Medicine, El-shatby Maternity University Hospital, Alexandria University, Alexandria, Egypt 123 Indian J Gynecol Oncolog DOI 10.1007/s40944-016-0041-9