Pulmonary embolism in the setting of HELLP syndrome

•HELLP syndrome may be complicated by severe multi-organ dysfunction.•It may be difficult to differentiate HELLP syndrome from amniotic fluid embolism and acute fatty liver of pregnancy.•HELLP syndrome is a microangiopathic hemolytic disorder with potential for major thrombotic complications.•Management should include transfer to intensive care and multidisciplinary discussion.

HELLP syndrome (hemolysis, elevated liver enzymes and low platelets) complicates 0.5–0.9% of pregnancies and is frequently associated with multiorgan dysfunction. Treatment relies on prompt diagnosis, delivery and supportive care. The clinical presentation may make the concurrent diagnosis and management of other disease entities challenging. This case report describes a patient with postpartum HELLP syndrome complicated by severe multiorgan dysfunction and pulmonary embolism.