What is the most likely diagnosis for a 28-year-old woman presenting with severe abdominal pain, distension, nausea, vomiting, and a history of ovulation induction with human chorionic gonadotropin (hCG) injections, who has hyperleukocytosis, thrombocytopenia, and a pelvic ultrasound showing bilateral enlarged ovaries with multiple cysts and free fluid in the abdomen?

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Differential Diagnosis

  • Single most likely diagnosis
    • Ovarian Hyperstimulation Syndrome (OHSS): This diagnosis is the most likely due to the patient's recent ovulation induction treatment, as evidenced by the last hCG injection 7 days ago. The symptoms of severe abdominal pain, distension, nausea, vomiting, and the laboratory findings of hematocrit 56%, leukocytes 26,000/mm3, and the pelvic ultrasound showing bilateral enlarged ovaries with multiple cysts and a large amount of free fluid within the abdomen are all consistent with OHSS.
  • Other Likely diagnoses
    • Ovarian torsion: This diagnosis is possible due to the presence of enlarged ovaries with multiple cysts, which can increase the risk of ovarian torsion. However, the absence of a sudden onset of severe pain and the presence of other symptoms such as nausea and vomiting make OHSS more likely.
    • Spontaneous rupture of an ovarian cyst: This diagnosis could explain the abdominal pain and free fluid in the abdomen, but the presence of multiple cysts and the recent ovulation induction treatment make OHSS a more likely diagnosis.
  • Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
    • Ectopic pregnancy: Although the patient's β-hCG level is not significantly elevated, an ectopic pregnancy could still be present, especially in a patient undergoing fertility treatment. A missed diagnosis of ectopic pregnancy could be life-threatening.
    • Appendicitis: This diagnosis is possible, but the absence of rebound tenderness and guarding makes it less likely. However, appendicitis can be deadly if missed, especially in a patient with severe abdominal pain.
  • Rare diagnoses
    • Other causes of acute abdominal pain, such as intestinal obstruction or mesenteric thrombosis, are possible but less likely given the patient's history and laboratory findings.
    • Hemorrhagic ovarian cyst: This diagnosis could explain the abdominal pain and free fluid in the abdomen, but it is less likely given the presence of multiple cysts and the recent ovulation induction treatment.

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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