Subsequently, the patient was transferred to gynecology where she was closely monitored. During her stay, the ascites reduced, the shortness of breath improved and the following week, she was discharged home with no symptoms. 3. Discussion This case has illustrated a diagnosis that is important in patients who are of reproductive age. We have reported a case of severe OHSS which was mistaken for thromboembolic disease due to an inadequate history combined with a reliance on blood tests

that could have potentially led to serious complications. Sorafenib The complications of OHSS depend on the severity of the condition although a misdiagnosis and mistreatment can potentially become fatal. Complications from mild cases are usually self-limiting. In the more severe forms, fluid shifts can lead to dehydration resulting in acute kidney injury, multiple organ failure, and adult BGJ398 respiratory distress syndrome. Dehydration also increases the risk of thromboembolic phenomena and this occurs in 0.7% to 10% of OHSS patients [9]. Thromboembolic disease is therefore an important condition to rule out in any potential patient who has had assisted reproductive technologies (ART). This promotes the rationale behind the referral of our patient to the MAU with a suspected pulmonary embolus. However, it also highlights the importance of taking a thorough medication history, which revealed that the patient

had recently been started on a low-molecular weight heparin in addition to thromboembolic stockings, two factors that reduce the risk of a thromboembolic disease. In OHSS, the pathophysiology behind the raised d-dimer is thought to be due to an elevation of prostaglandins, which increase vascular permeability and result in extravasation of fluids into the third space. Extravasation leads to hemoconcentration, which in turn increases serum viscosity and slows blood

flow. The hematological changes increase endothelial adherence of platelets Mephenoxalone and activate the coagulation cascade. In order to prevent the formation of thrombi, the body generates endogenous hormones to dissolve the fibrin clot. This ultimately increases fibrin degradation products which are measured as the d-dimer [10]. This whole process is illustrated in Figure 1. Figure 1 Schematic illustration of how OHSS causes a rise in d-dimers. Pg = prostaglandin; Plt = platelets; FDP = fibrin degradation productions; PT = prothrombin. (1) Dotted arrow represents normal blood flow. Prostaglandins are increased in OHSS which causes … This case imparts an important lesson regarding the interpretation of the investigations performed in the ED, especially the d-dimer. D-dimers are fibrin degradation products, which have a high sensitivity but low specificity. They can be elevated in a plethora of conditions including infection, inflammatory disease, malignancy, OHSS, and pregnancy [11].